Dr. Benjamin Han, a geriatrician and addiction medicine expert, explains that when meeting new patients at the University of California, San Diego School of Medicine, he discusses common health problems older people face: chronic illness, functional capacity , drugs and their effects.
He also asks about tobacco, alcohol, cannabis, and other non-prescription drug use. “Patients tend not to want to reveal this, but I put it in a health context,” Dr. Han said.
he tells them: “As you age, physiological changes occur that make your brain more sensitive. When your body changes, your tolerance decreases. That can put you at risk.”
This is how he learned that people with insomnia might be using stimulants, possibly methamphetamine, to help them be active in the morning. Alternatively, patients who have been taking opioids for chronic pain for many years have encountered problems with additional gabapentin prescriptions, for example.
When one 90-year-old patient, a woman who was healthy enough to take the subway to her previous hospital in New York City, began complaining of dizziness and falls, it took Dr. Han a while to figure out why. She washed off the prescribed pills. The number increased as she got older, and she drank a glass of brandy.
He has worked with older patients whose heart disease, liver disease and cognitive impairment are likely exacerbated by drug use. Some have overdosed. Some died despite his best efforts.
Until a few years ago, despite the raging opioid epidemic, health care providers and researchers paid limited attention to drug use by older adults. Concerns centered on young working-age victims who suffered the most.
But as baby boomers approached age 65, the age at which they generally qualify for Medicare, substance use disorders among the elderly skyrocketed. “The cohorts had habits of drug and alcohol use that persisted throughout their lives,” said Keith Humphries, a psychologist and addiction researcher at Stanford University School of Medicine.
Aging Boomers “still used far more drugs than their parents did, and the scene was unprepared for that.”
Evidence is mounting that the problem is getting worse.Research opioid use disorder For example, the number of people aged 65 and over with traditional Medicare tripled in just five years, from 4.6 per 1,000 in 2013 to 15.7 per 1,000 in 2018.
Co-author of the study, Tsechuan Yang, a sociologist and demographer at the University of Albany, said that stigma about drug use may lead people to underreport drug use, so the actual drug He said usage could be even higher.
Fatal overdoses are also on the rise among the elderly. From 2002 until 2021 he Overdose deaths quadruple Dr. Humphries and co-author Chelsea Schober used data from the Centers for Disease Control and Prevention and reported in JAMA Psychiatry in March. These deaths can be intentional, such as suicide, or accidental, reflecting drug interactions or mistakes.
Most drug use disorders in older adults involve prescription drugs, not illicit drugs. And since most Medicare beneficiaries take multiple medications, it’s “easy to get confused,” Humphries said. “The more complex the regimen, the more likely it is that mistakes will be made. And overdoses.”
So far, the numbers have remained relatively low, with 6,700 drug overdose deaths among people 65 and older in 2021, but the rate of increase is alarming.
“That’s what people would say about overdose deaths in general in 1998. The absolute numbers were low,” Dr. Humphries said. “If you don’t react, you’re in a sad state.” Over 100,000 Americans died of drug overdose last year.
Alcohol also plays a big role. last year, Substance Use Disorder Researchlooks at the difference between Medicare subscribers under 65 (who may be eligible due to disability) and those over 65, based on federal research, to determine which medications older Americans use was analyzed.
Of the 2% of recipients age 65 and older who reported a substance use disorder or dependence in the past year (equivalent to more than 900,000 seniors nationwide), more than 87% were alcohol abusers. (including alcohol) 11,616 elderly deaths 2020 saw an 18% year-over-year increase. )
In addition, approximately 8.6 percent of illnesses involved opioids, most of which were prescription pain relievers. 4.3% were related to marijuana. Two percent involved non-opioid prescription medications such as tranquilizers and anxiolytics. William Parrish, lead author and health economist at RTI International, a nonprofit research organization, said the categories overlap because “people often use multiple substances.” .
Most people with drug problems do not die from an overdose, but the health consequences include injuries from falls and accidents, accelerated cognitive decline, cancer, heart disease, liver disease, and kidney failure. It can get serious.
“Comparing suicidal ideation rates is particularly heartbreaking,” said Dr. Parrish. Older Medicare beneficiaries with substance use disorders were more than three times more likely to report “severe psychological distress” than those without such disorders (14% vs. 4%). About 7 percent had suicidal thoughts, compared to 2 percent who did not report a substance disorder.
However, few of these older adults have received treatment in the past year, only 6%, compared with 17% of younger Medicare beneficiaries, and even made no effort to seek treatment. I didn’t.
“With these addictions, it takes a lot of time for someone to be ready for treatment,” said Dr. Parrish, who said nearly half of respondents over the age of 65 lacked the motivation to begin treatment. pointed out that
But they also face more barriers than younger people. “There is a high rate of stigma concerns, such as worrying about what neighbors will think,” said Dr. Parrish. “We see more logistical barriers such as access to transportation, not knowing where to go for help, and not being able to afford care,” he said.
“The treatment system may be difficult for older people to navigate,” says Dr. Parrish.
Uneven Medicare coverage is also an obstacle. The Federal Equality Act mandates equal coverage for mental health (including addiction treatment) and physical health, and includes private employer insurance, state health care exchange programs, the Affordable Care Act market, and most We guarantee equal benefits in our Medicaid plans.
But senior health policy attorney Deborah Steinberg said that never included Medicare. legal action centera non-profit organization dedicated to expanding equitable coverage.
Defenders have also made some inroads. Medicare covers drug use screening and, in 2020 and beyond, opioid treatment programs like methadone clinics. In January, following a move by Congress, it will cover treatment by a wider range of health professionals, including “intensive outpatient care,” which typically provides 9-19 hours of counseling and education per week.expanded Benefits of telemedicinePrompted by the pandemic, also helped.
However, more intensive care may be less accessible and residential care is not covered at all. Medicare Advantage plans have more restricted provider networks and stricter pre-approval requirements. “We’re getting even more complaints from Medicare Advantage recipients,” Steinberg said.
“We are really making progress,” she added. “But more people are dying from overdoses because they don’t get treatment.” Physicians are also unfamiliar with diagnosing substance abuse in older people and may overlook the risks.
In a generation whose early drinking and drug use sometimes makes for funny anecdotes (the common refrain, “If you can remember the ’60s, you weren’t there”), how vulnerable are we? It can be difficult to recognize what is there. .
“The person may not be able to say that I am addicted,” Dr. Humphries says. “This is the Rubicon that people don’t want to cross.”
He added that the joke about dropping acid at Woodstock “makes me colorful.” “Pulling up OxyContin and snorting it doesn’t change the color.”
