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Older adults at risk of experiencing harm related to substance use

When a 24-year-old person walks into a doctor’s office appearing confused, agitated or tired, the physician will know something is amiss and will explore the potential that this person has consumed drugs. But there is a good chance that the same symptoms will not raise red flags for a 74-year-old patient. In addition, an older adult’s dwindling social circle can increase the risk of challenges related to substance use going unnoticed.

When you throw in substance use in addition to numerous physical and mental health issues, that creates great challenges.
— Dr. Tony George Clinical researcher and chief of addictions at the Centre for Addiction and Mental Health

“We often make the mistake of assuming that the reason certain things are happening to someone over the age of 55, for example a fall or decline in physical and mental capacities, is simply because they are getting older,” says Rita Notarandrea, CEO of the Canadian Centre on Substance Use and Addiction (CCSA). She believes the failure to detect – and subsequently address – problematic substance use can make older adults especially vulnerable.

Adults aged 55 and over represent the nation’s fastest growing demographic and are estimated to account for approximately one-quarter of the Canadian population by 2036 – a shift that will impact society and the health-care system, says Notarandrea. “We have to better understand the needs of older adults and provide the tools and resources to ensure Canadians can have a good quality of life as they age.”

Empirical evidence shows that older adults use both licit and illicit substances, including psychoactive prescription medication and drugs for recreational purposes. Dr. Tony George, clinical researcher and chief of addictions at the Centre for Addiction and Mental Health (CAMH), calls substance use in older Canadians “a hidden epidemic.”

While many substance use disorders start at an earlier age, there is a “second wave related to aging that involves the use of one or more drugs, with the most common being alcohol and cannabis,” says Dr. George. “We know that women, for example, tend to develop problems with alcohol later in life. That’s when we see a phenomenon called telescoping – which means the situation escalates quickly.”

The body of an older person is less capable of processing substances, such as stimulants like cocaine, or alcohol and cannabis, so negative effects can be much more profound, says Dr. George. And as Canadians age, they may experience challenges like depression, dementia or other cognitive disorders, plus a range of prevalent chronic conditions like cardiovascular and respiratory diseases or diabetes, he adds. “When you throw in substance use in addition to numerous physical and mental health issues, that creates great challenges.”

Statistics show that two-thirds of Canadians over 65 have five or more different prescriptions, says Dr. Zachary Patterson, knowledge broker at the CCSA. “While poly-pharmacy – the practice of taking multiple medication at the same time – can provide help for coping with age-related health deterioration, it also carries certain risks, such as drug-to-drug interactions or taking too much or not enough of certain medications.”

This combination of circumstances can create adverse outcomes for Canada’s older people, says Dr. Patterson. “If you compare a 24-year-old healthy adult to someone over 70, with both individuals using the same substance and same doses, we know that the older person is more susceptible to experiencing harm.”

Among the key difficulties older adults commonly face are confusion, injuries related to falls and social isolation – and all three can be exacerbated by substance use, says Dr. Patterson. “When older people become more confused or experience falls that lead to hospitalization, it can severely impact their capacity to live independently.”

Notarandrea calls for a closer look at transitions that commonly happen later in life and their potential physiological, psychological and social impacts. A recent CCSA report titled Improving Quality of Life: Substance Use and Aging aims to “give decision makers, policy makers, nurses, geriatricians, researchers and others working with older adults an opportunity to consider the evidence as they develop and employ more effective prevention and intervention programs aimed at addressing substance use among older adults.”

Dr. George hopes the report will increase awareness that there is a critical unmet need. “Hopefully, we will get policy makers and politicians to see that there is a gap and consider putting some resources towards closing it,” he says.

What is needed is an evidence-informed response from society, says Notarandrea. “We need to equip the health-care system with the appropriate means to prevent, assess and treat harmful substance use in this demographic.” Dr. Patterson adds that awareness at the personal, community and societal level can create a support network and better outcomes for Canada’s older adults.

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