Opioid use disorder rising fastest among older Americans

The opioid epidemic that has resulted in the overdose deaths of about 806,000 people in the United States since 1999—from both prescription and illegal forms of the drug—has generated what healthy aging expert Marcia G. Ory, PhD, calls a “veritable mountain” of data.

“We know a great deal about what’s behind it, its effects on individuals and society and the myriad programs put in place to reduce it,” said Ory, a Regents and Distinguished Professor with the Texas A&M University School of Public Health. “But until now, the epidemic’s effects on older adults with opioid use disorder have been largely ignored.”

To help close this gap, Ory and colleagues Ashley Ritter, PhD, from Hunter College and Sarah Gebauer, MD, from Saint Louis University produced a special issue of Innovation in Aging that summarizes the research.

Their overview reveals gaps in opioid overdose reporting and opportunities to shape policy to improve opioid-related care for older adults.

Ory said opioid use disorder is growing much faster among older adults compared to other segments of the population, resulting in “staggering” rates of hospitalization, social isolation and overdose deaths—and current estimates likely are lower than the actual numbers and underestimate the impact on families and communities at large.

“Getting older brings changes in health, relationships and daily life that can make living with opioid use disorder harder, and these changes also affect whether the help that is available is what older adults truly need,” said Ory, who is also associated with the school’s Center for Community Health and Aging and its university-wide opioid task force.

To categorize the research on this complex topic, the author posed the social ecological model, which has four concentric circles representing the levels at which interventions or programs could have an influence: individual, interpersonal, community and society.

Using this framework, the team highlighted the following issues that older adults with opioid use disorder face:

• Pain management. Many older adults experience chronic pain and thus rely on opioids for pain relief.
• Discontinuation or reduction of opioid use. Lowering the recommended doses of prescription opioids, as the Centers for Disease Control and Prevention did in 2016, can be beneficial when tailored to the individual patient’s needs. These protocols were not designed for older adults, however. In addition, individualized medical and social services for older adults, who are more likely to have comorbid conditions requiring more complex management, are limited.
• Social withdrawal. Isolation was found to contribute to opioid use disorder among older adults, while peer support helped prevent it. Misuse of opioids can lead older adults to withdraw from relationships, increasing loneliness and isolation, which are detrimental to health. In addition, opioid misuse among family members or paid caregivers can result in elder mistreatment and neglect.
• Stereotypic notions about substance abuse. The widespread stigma associate with addiction, as well as health care infrastructure barriers such as a lack of geriatric care providers and patients’ ability to travel to and afford health care, also contributed to isolation.

“Underlying these issues are significant gaps in data reporting for older adults with opioid use disorder and the many institutional, state and federal policy barriers facing older adults who seek treatment,” Ory said.

Data reporting challenges could be addressed by standardizing and integrating opioid data, such as by using diverse datasets to identify interventions based on the needs of populations in different locations, she said.

Despite recent attention, healthcare infrastructure barriers are still prevalent and include poorly aligned regulations and inconsistent practices across care environments to support people with opioid use disorders.

“These barriers impair the delivery of evidence-based medications to treat opioid use disorder and other therapies for people with overlapping medical, behavioral and social needs,” Gebauer said.

Ritter added that policy barriers could be reduced with care models tailored to the needs of older adults.

“Addressing the multifaceted needs of older adults with opioid use disorder will require integration of services and innovation across the continuum of care,” she said.