As a matter of course, geriatric psychiatrist Susan Lehmann asks her patients struggling with their mental health if they drink alcohol or use drugs. In recent years, she’s noted that more of these patients in their 60s, 70s — and even 80s — have answered yes to that question. “I thought to myself, ‘Something’s going on here.’”
Indeed, recent projections show that by 2020, substance use disorders among adults over age 50 will increase to 5.7 million, up from 2.8 million in 2006. The rise in use of alcohol and drugs, says Lehmann, is in large part attributed to baby boomers — those born between 1946 and 1964. The leading edge of this large demographic group turned 65 in 2011. Many, she says, came of age during an era of substance experimentation and have been “using” for decades.
“We should be worried not only because these older adults are misusing alcohol or other substances,” she says, “but because their aging bodies and brains are more vulnerable to harmful effects of these substances.” Because the abuse often occurs in tandem with prescription medication use and medical comorbidities, older adults are at greater risk for falls, fractures, car accidents and other emergencies.
As director of the Geriatric Day Hospital program, as well as the psychiatry clerkship, Lehmann feels an urgency to educate psychiatrists and physicians across all specialties about what she calls an under-recognized national public health problem. She believes the most effective intervention is to raise awareness among all clinicians, so that substance use disorder among older adults can be addressed sooner rather than later.
Building on national efforts, she and Michael Fingerhood, addiction specialist and medical director of the Johns Hopkins Comprehensive Care Practice, expressed their concerns about substance use disorder in late life in a recently published review article in The New England Journal of Medicine. The need for more research is great, says Lehmann, because data on changing patterns of substance abuse over time are lacking.
Lehmann hopes further research on older adults with substance use disorders will lead to better-targeted screening methods and new models of care. And the earlier these patients are assessed the better, adds Lehmann.