While older adulthood is a special time of life, it is also a time when older individuals may face health issues and life transitions. It can be a vulnerable time for mental health and can lead to a change in the way people use substances. New York State has the fourth-largest population of older adults in the United States, with 3.8 million individuals over age 60. As the population ages, high-risk alcohol and substance use, particularly cannabis and prescription medications, is growing among older adults. Drug overdose deaths among older adults have been rising over the past two decades, largely due to opioids.1
The New York State Office of Addiction Services and Supports (OASAS) is the state agency that oversees one of the nation’s largest substance use disorder (SUD) systems of care and is committed to serving all people with equity, dignity, compassion, and respect – including older adults who may find themselves dealing with SUDs later in life.
OASAS has collaborated with the New York State Office for the Aging (NYSOFA) on a nine-county pilot initiative to educate older adults on health, substance use, and mental health wellness. Established in 2023, the Wellness Initiative for Senior Education (WISE) program aims to help seniors increase their knowledge and awareness of issues such as safe medication use, the aging process, communication with healthcare providers, and healthy lifestyle choices. It is paired with Screening, Brief Intervention, Referral to Treatment (SBIRT) services using the Alcohol Use Disorders Identification Test (AUDIT-C).
The Importance of Older Adult SUD Screening and Services
With aging can come new stressors, such as loss of partners, lower income, a reduced sense of purpose or work identity, and a shrinking social network. It can also bring physical changes like increased inflammation and pain, elevated cancer risks, heart disease, and other chronic health conditions, as well as cognitive decline and sleep problems. Substance use can compound these health issues – especially since many older adults also take medications, including prescriptions, over-the-counter, or herbal remedies that can be dangerous or even deadly when mixed with alcohol.
Isolation is another risk factor for increased depression, anxiety, and substance use. The COVID pandemic exacerbated this isolation. Some research found that the percentage of adults ages 50-80 who felt isolated from others some of the time has largely improved from the height of the pandemic in 2020 but still exceeds pre-pandemic 2018 rates. Socially isolated older adults are left further vulnerable as they go through stressful life events common to aging without the buffering effects of social support.2
Drug Overdose Deaths Among Older Adults on the Rise
Among recent notable changes in key health indicators is the increase in substance-related deaths in adults ages 65+ between 2016 and 2021. Opioid overdose deaths surged more dramatically than the overall drug overdose death rate (involving all drug types), more than doubling since 2014 in older adults. Overdose deaths due to synthetic opioids (i.e., fentanyl and tramadol) increased 175% among older adults between 2016 and 20213 – and older adults are among those most impacted by the opioid crisis, as they are often prescribed opioids to help them cope with chronic pain or recover from surgical procedures.4 In addition, the opioid overdose death rate significantly varied by race/ethnicity and gender, with rates highest among Black older adults compared with other demographics – although rates were generally higher for all groups. Further, rates are higher among males than females.
How the WISE/SBIRT Initiative Helps Older Adults
WISE is a curriculum-based health promotion program to help older adults increase their knowledge and awareness of issues related to health and the aging process. Based on the health belief model of behavioral change, WISE provides older adults with the information and resources required to maintain a healthy lifestyle and become empowered regarding their healthcare needs.
Program objectives include helping participants to (1) understand how lifestyle choices and behaviors impact health; (2) learn to use tools and feel empowered to manage health care, particularly regarding the use of medications; (3) understand the aging process and how it affects the metabolism of alcohol and medications; (4) develop an appreciation for cultural and generational diversity, including their own increasing age; and (5) recognize the early signs and symptoms of depression.
The six-lesson WISE curriculum is delivered by trained substance abuse prevention specialists at small 2-3-hour group sessions held weekly over a 6-week period. The lessons are presented through a mix of lectures, discussions, small-group activities, and individual exercises. Participants are also given tools and resources for use at home, which increases the likelihood that they will put into practice and share what they have learned. The WISE-SBIRT Pilot was delivered in over 29 unique locations, including Office of Aging Nutrition Sites, community centers, churches, senior centers and housing facilities, and Firehouses and Town Halls.
During the first year of implementation, 1,074 older adults participated in the WISE-SBIRT Pilot, and 1,050 older adults were screened for alcohol/substance use. Preliminary results showed increased perception of harm from alcohol use, prescription medication misuse, and combined alcohol/prescription use. There was decreased alcohol use among participants who drank, and 77% reported changing to a healthier lifestyle.
The program was well received by participants, partner sites, and prevention providers, who frequently requested additional programming. Meeting participants in familiar community settings serving older adults improved access to prevention and wellness programming. Framing interventions about substance use/misuse in a broader “healthy aging” context builds rapport and engagement.
OASAS will continue to assess and build upon the progress made through the WISE-SBIRT pilot program. That means exploring data-driven, person-centered strategies that enhance prevention, harm reduction, and treatment options for older adults. It also means ending the stigma towards substance use and SUD – while strengthening the social networks so important to an older adult’s health, well-being, and recovery.
Patricia Zuber-Wilson is Associate Commissioner for Prevention at NYS Office of Addiction Services and Supports (OASAS).
Footnotes
- Kramarow, Ellen, et al. “Drug Overdose Deaths Among Adults Aged 65 and Over: United States, 2000-2020.” NCHS Data Brief No. 455. Hyattsville, MD: National Center for Health Statistics, November 30, 2022. org/10.15620/cdc:121828.
- Elder, Katie, et al. “Framework for Isolation in Adults Over 50.” AARP Foundation, 2012. aarp.org/ content/dam/aarp/aarp_foundation/2012_PDFs/AARPFoundation-Isolation-Framework-Report.p
- CDC WONDER, Multiple Cause of Death Files
- Administration for Community Living. “Addressing the Opioid Crisis,” February 13, 2023. acl.gov/ programs/addressing-opioid-crisis
