BETHESDA, MD. — Current trends in the increase in the number of Americans aged 65 years and older could have significant implications for managing substance abuse in this population.
By 2030, 20% of the population in the United States will be older than 65 years (currently, that percentage is 13) and in 2 years' time, the first wave of Baby Boomers will be eligible for Social Security. Both trends will place pressure on substance abuse prevention and treatment, Frederic C. Blow, Ph.D., said at the annual meeting of the Association for Medical Education and Research in Substance Abuse. The conference was jointly sponsored by Brown Medical School.
“The number of adults with substance abuse disorders is projected to double from [an annual average of] 2.8 million in 2002–2006 to 5.7 million in 2020,” he said. Elderly adults who abuse alcohol or drugs are more likely to have mental health comorbidities, especially depression, cognitive loss, or anxiety or sleep disorders, as well as other comorbidities such as heart disease, diabetes, or conditions that require treatment for pain.
Dr. Blow of the University of Michigan, Ann Arbor, said aging-related changes make older adults more vulnerable to the adverse effects of alcohol, so that even moderate amounts of alcohol can be riskier for elderly drinkers.
“They are three times more likely to develop a mental disorder with a lifetime diagnosis of alcohol abuse, with common dual diagnoses, including depression [20%-30%], cognitive loss [10%-40%], and anxiety disorders [10%-20%],” said Dr. Blow, who also noted an association between alcohol abuse and suicide.
When it comes to screening for alcohol abuse problems, one should ask direct questions, though in doing so it is preferable to frame the question so that it is linked to a medical condition and avoid using stigmatizing terms such as alcoholic, Dr. Blow advised.
“Every person over 60 should be screened for alcohol and prescription drug abuse as part of the regular physical examination—and screen or rescreen if certain physical symptoms are present or if the older person is undergoing major life transitions,” he added.
Among the tools that can be used for screening and assessing alcohol use in the elderly are the Alcohol-Related Problems Survey and its shorter version, the shARPS; the Computerized Alcohol-Related Problems Survey, which combines screening assessment with health education; and two that are “elder-specific”—the Michigan Alcoholism Screening Test–Geriatric Version and the Short Michigan Alcohol Screening Instrument–Geriatric Version.
In regard to drinking limits, older men should have no more than one drink a day on average, and older women should have less than one a day, Dr. Blow said.
Brief interventions focusing on physician lifestyle guidance or in-home motivational enhancement have both been found to reduce alcohol use in at-risk older adults and alcohol-related harm, and as a result, health care use. When it comes to treatment, however, age-appropriate treatment models are essential. “The current bias toward institution-based services conflicts with expressed preferences and needs of older persons,” said Dr. Blow.
Dr. Blow said that he had no financial disclosures.