A Wake-Up Call: Substance Abuse Among Older Adults

RESEARCH UPDATE

Despite growing awareness and dangers of opioid diversion, misuse among older adults has skyrocketed, according to research emerging from the College of Health Professions at Towson University in Towson, Maryland.¹ Carter and colleagues examined nationally representative, cross-sectional data from the Nationwide Emergency Department Sample (NEDS) for years 2006, 2009, 2011, and 2014.

The goal: to retrospectively describe opioid-related prevalence rates, risk factors, trends, and outcomes among adults age 65 and older. NEDS is the largest all-inclusive payer source of US emergency department (ED) visits.²

The authors pointed out that, although health experts and public policy have responded to the opioid epidemic with action plans for younger populations, research and mobilization regarding opioid misuse among senior adults has been lacking. This is despite higher use of prescription opioids among older adults.  

The researchers identified 126,931 ED visits associated with at least one ICD-9-CM code alluding to opioid misuse among adults aged 65 years or older. The data, however, showed a steep increase over time that was particularly pronounced between years 2011 and 2014.

Opioid misuse among seniors accounted for 11% of ED visits in 2006 and 44% in 2014, representing a 220% increase in opioid misuse among the study population across 8 years. Indeed, the data suggested that, by 2014, nearly 6.4 opioid-related ED visits involving older adults were occurring every hour in the United States. The hospitalization rate was 30% higher among older adults whose visits were associated with opioid misuse compared with other older adults who found themselves in the ED (69% vs 39%).

Older adults admitted to the ED for opioid misuse were generally younger than other seniors in the ED (72 vs 77 years) but had twice as many chronic conditions (7 vs 4, P < .001). They were more likely to have a history of alcohol abuse (10% vs 1%, P < .001) and more apt to have had a history of injuries (30% vs 20% P < .001).

Older adults admitted to the ED for conditions involving opioid misuse also were more likely to have diagnostic codes on record that indicated mood disorders, alcohol-related disorders, mental health/substance use history, respiratory failure, anxiety disorders, and nutritional deficiencies. The study authors pointed out that the psychosocial findings were in keeping with findings from the general literature on substance abuse.³

As for risk profiles, the logistic regression analysis determined that adults age 65 to 74 years were 7 times more likely to engage in opioid misuse than adults age 75 years and older and that older women were more likely than their male peers to have opioid misuse identified during an ED visit (OR =1.12; P<.001). Also, the more chronic conditions an older visitor to the ED had, the higher the likelihood of opioid misuse.

ED encounters associated with alcohol dependence and injury also strongly increased the odds of identifying opioid misuse (OR =2.88 and 2.89, respectively; P<.001). Finally, the higher the income bracket of the patient, the lower the odds of identifying opiate misuse in the ED and the less likelihood of hospitalization if it was identified. The converse was increasingly the case the lower the income bracket of the patient.

These findings highlight the complexity of the opioid crisis among older adults and suggest that the problem does not simply involve unintentional medication mishaps among a few older persons. Instead, it includes long-time patterns of substance use disorder that go hand-in-hand with alcohol dependency and anxiety and mood disorders. The authors called for greater efforts toward intervention and community outreach.

References:

1. Carter MW, Yang BK, Davenport M, Kabel A. Increasing rates of opioid misuse among older adults visiting emergency departments. Innov Aging. 2019;3(1):igz002

2. Healthcare Cost and Utilization Project (HCUP). NEDS overview. Agency for Healthcare Research and Quality (AHRQ). https://www.hcup-us.ahrq.gov/nedsoverview.jsp. Accessed May 13, 2019.

3. Lai HM, Cleary M, Sitharthan T, Hunt GE. Prevalence of comorbid substance use, anxiety and mood disorders in epidemiological surveys, 1990-2014: A systematic review and meta-analysis. Drug Alcohol Depend. 2015;154:1-13.