Opioid Problems Among Older Adults

Opioid Problems Among Older Adults

Older adults are more susceptible to drug effects since the body cannot break them down easily as it ages. Also, older adults are more likely to unintentionally misuse medicines by forgetting to take them, taking them too often, or taking the wrong amount (NIDA, 2020). To elaborate, there were 46,802 opioid overdose deaths in 2018 within the United States (Wilson, Kariisa, Seth, et al., 2020). In terms of Hawaii, the average opioid death rates among older adults in 2015 were (n=275 people): 1) 42 opioid overdoses for 50-59-year-old adults; 2) 28 opioid overdoses for 60-69-year-old adults; and 3) 3 opioid overdoses for 70+-year-old adults (Galanis, 2017). Also, Hawaii’s unintentional poison death rate (per 100,000 persons) among older adults were: 1) 23.4 deaths for 50-54-year-old adults; 2) 35.7 deaths for 55-59-year-old adults; 3) 21.8 deaths for 60-64-year-old adults (Hawaii State Department of Health, 2017).

Overdose Risk Factors Older Adults Face:

  • High rates of painful conditions
  • Self-medication
  • Depression
  • Dementia
  • Cognitive impairment
  • Social isolation
  • Poor support systems (Passik, Rzetelny, Kirsh, 2019)

Impact Of Opioid Misuse On Older Adults

The prevalence of opioid misuse involved emergency department (ED) visits has increased among adults aged 65 years and older from 2006 to 2014 within the U.S. To elaborate, 14,407 observed opioid misuse ED visits in 2006 increased to 55,413 observed opioid misuse ED visits in 2014. Also, 68.8% of ED visits with opioid misuse in 2014 resulted in hospitalization (Carter, Yang, Davenport, et al., 2019).

In addition, opioid misuse was associated with an increased number of chronic conditions, greater injury risk, higher rates of alcohol dependence, and mental health diagnosis (Carter, Yang, Davenport, et al., 2019).

Another study reported out of 400,421 older adults aged 55 years and older who sought treatment for opioid use disorder, there was a 41.2% increase of these cases between 2004 and 2013, and a 53.5% increase between 2013 and 2015 (Huhn, Strain, Tompkins, et al., 2018).

Other adverse effects in older adult opioid use in long-term care include respiratory depression, constipation, urinary retention, orthostatic hypotension, myoclonus, and nausea. Along with that, opioid use for chronic pain has been associated with an increased risk for fractures in older adults (Suriaga & Tappen, 2020).

Given that, opioids predispose older adults to opioid use disorder and higher mortality risk, it is important to practice preventive and intervention strategies.

What To Do During An Active Opioid Overdose

  1. Call 911
  2. Ask the person questions to keep them awake
  3. If they’re not breathing, turn them on their side
  4. Give first aid as directed by 911 until help arrives
  5. If NARCAN is available, safely administer NARCAN*
  6. If you’re qualified to do so, perform CPR** until help arrives (Banyan Treatment Centers, n. d.)

*NARCAN – Naloxone: An opioid antagonist used to reverse the effects of opioids. (Talk to your Primary Care Physician to learn more about NARCAN.

**CPR – Cardiopulmonary Resuscitation: An emergency procedure that combines chest compressions often with artificial ventilation.

Protective Factors Among Older Adults

  • Social Support (family and friends)
  • Be non-judgmental of substance use
  • Be mindful of substance use history
  • Know signs of a drug overdose
  • Monitor substance use with a doctor
  • Seek support from a therapist (Goodin, Bulls, and Herbert, 2019)

Questions To Ask Kupuna To Prevent A Drug Overdose

  • Have you heard that there are more risks to use drugs the older you get?
  • What do you take your medicine for?
  • Do you know someone who can help you?
  • How do you take care of yourself?
  • What do you do to cope with pain?
  • Where do you go to get treatment?
  • Who do you talk to for support?
  • How do you remember when to take your medicine? (NIDA, 2020)

References

Carter, M. W., Yang, B. K., Davenport, M., & Kabel, A. (2019). Increasing Rates of Opioid Misuse Among Older Adults Visiting Emergency Departments. Innovation in aging, 3(1), igz002. https://doi.org/10.1093/geroni/igz002

Galanis, D. (2017). Autopsy records of the Department of the Medical Examiner. City and County of Honolulu.

Goodin BR, Bulls HW, and Herbert MS. (2019). A Biopsychosocial Perspective on the Assessment and Treatment of Chronic Pain in Older Adults. Springer
Science+Business Media. 131-151. https://dl.uswr.ac.ir/bitstream/Hannan/32416/1/9781493988259.pdf#page=136. Accessed April 15, 2020.

Hawaii State Department of Health. (2017, February). Poisoning Death Rate (Unintentional). Hawai‘i Health Matters. http://www.hawaiihealthmatters.org/indicators/index/view?indicatorId=2405&localeId=14.

Huhn, A. S., Strain, E. C., Tompkins, D. A., & Dunn, K. E. (2018). A hidden aspect of the U.S. opioid crisis: Rise in first-time treatment admissions for older adults with opioid use disorder. Drug and alcohol dependence, 193, 142–147.

NIDA. 2020, July 9. Substance Use in Older Adults DrugFacts. Retrieved from https://www.drugabuse.gov/publications/substance-use-in-older-adults-drugfacts on 2021, August 6

Passik, S. D., Rzetelny, A., & Kirsh K. (2019) Assessing and Managing Addiction Risk in Older Adults with Pain. Effective Treatments for Pain in Older Patients. 177-189. https://dl.uswr.ac.ir/bitstream/Hannan/32416/1/9781493988259.pdf#page=181.

Suriaga, A., & Tappen R. M. (2020). A Systematic Review of Opioid Use in LTC. Annals of Long-Term Care. Retrieved May 19, 2020, from https://www.managedhealthcareconnect.com/articles/systematic-review-opioid-use-ltc

U.S. Department of Health and Human Services (HHS). (2018, September). Facing Addiction in America: The Surgeon General’s Spotlight on Opioids. https://www.addiction.surgeongeneral.gov/sites/default/files/Spotlight-on-Opioids_09192018.pdf.

U.S. National Library of Medicine. (2018, August 27). Opioid Misuse and Addiction Treatment. MedlinePlus. https://medlineplus.gov/opioidmisuseandaddictiontreatment.html.

Banyan Treatment Centers. (n.d). What To Do If Someone Overdoses from Drugs or Alcohol. Banyantreatmentcenter.com. https://www.banyantreatmentcenter.com/2018/01/10/signs-of-drug-overdose/. Accessed April 22, 2020.

Wilson N, Kariisa M, Seth P, et al. Drug and Opioid-Involved Overdose Deaths — United States, 2017–2018, Morbidity and Mortality Weekly Report. March
20, 2020; 69(11);290–297, https://www.cdc.gov/mmwr/volumes/69/wr/mm6911a4.htm#T1_down. Accessed August 8, 2021.