The Phoenix

Ageism, stigma hinder response to senior alcohol use disorder

- By Jessie Hellmann CQ-Roll Call This article was written with the support of a journalism fellowship from The Gerontolog­ical Society of America, The Journalist­s Network on Generation­s and The NIHCM Foundation.

Older adults are increasing­ly drinking excessivel­y and dying of alcohol-related deaths, and the problem has been compounded by ageism, stigma, a lack of interest from policymake­rs and health care providers and few age-appropriat­e treatment options, experts say.

“There is such a need to help this population,” said Nicole MacFarland, the executive director of Senior Hope Counseling, the only freestandi­ng outpatient clinic in New York that exclusivel­y treats people 50 and older.

The nonprofit specialize­s in geriatric addiction, leading group sessions focused on trauma, finding purpose later in life and other issues geared toward older adults. They also connect patients with local services and entitlemen­t programs.

Programs like MacFarland’s are rare, despite evidence that age-specific treatment can be beneficial: Only 25% of facilities surveyed by the Substance Abuse and Mental Health Services Administra­tion have programs that specialize in older adults.

And only 11% of the facilities have those programs and accept Medicare, the insurance program for people 65 and older.

“There are many older adults suffering silently, and not enough programs geared toward their age group and their need,” MacFarland said.

According to the 2021 National Survey on Drug Use and Health, 7.6% of adults 50 and older had an alcohol use disorder in the past year — a lower rate than other adult age groups, but one that, like other adult age groups, has increased in recent years.

Older adults are more likely to die from alcoholrel­ated causes, mostly from

chronic diseases associated with years of drinking. In 2020, the rate of alcoholind­uced deaths among 55to 64-year-old men was higher than in any other age group, according to the CDC, and was second highest among men aged 65-74. Rates among older women are also increasing.

A broader measure used by the CDC to estimate how many people die from alcohol-related causes, including cancer and car accidents, found an average of 48,000 people 65 and older died every year between 2015 and 2019 — more than any other age group.

The problem is poised to get worse as the population ages: By 2040, some 20.5% of the U.S. population will be 65 or older.

But with fewer medical profession­als specializi­ng in geriatrics, and even fewer of those profession­als specializi­ng in addiction training, the U.S. is not prepared to treat this growing need, experts say.

“The number of specialist­s is declining, and the number of older adults is increasing,” said Erin EmeryTibur­cio, an associate professor of geriatric and rehabilita­tion psychology at Rush University in Chicago.

While older adults have some of the greatest exposure to the health care system, physicians often fail to screen for excessive drinking. When they do, experts say, they rarely make referrals for treatment or prescribe medication­s that can treat alcohol use disorder.

Signs of excessive drinking can mimic symptoms of aging, like sleep problems, memory loss, depression or anxiety, meaning the problem often goes undetected.

“Ageism plays a massive role in substance use in particular for older adults because health care providers don’t screen,” Emery-Tiburcio said. “If you don’t think that the 80-year-old in front of you is drinking a bottle of wine at night, you’re not likely to ask him. You’re not likely to do anything about it.”

While the U.S. Preventive Services Task Force recommends screening for unhealthy alcohol use in primary care settings in all adults, more than half of adults age 65 and older who used alcohol and had a recent health care visit were not asked about their alcohol use, according to a study published in the journal Alcoholism in 2021.

Excessive alcohol use poses unique risks to older adults. As adults age, their tolerance for alcohol decreases, putting them at higher risk for falls, car crashes and other accidents. And alcohol can exacerbate diseases like diabetes, high blood pressure and memory problems and interfere with medication­s older adults are likely to take for those issues.

While medication-assisted treatment is an option for people diagnosed with alcohol use disorder, “I think if you were to ask a physician to name the three medication­s approved by the FDA to treat alcohol use disorder, they couldn’t,” said George Koob, director of the National Institute on Alcohol Abuse and Alcoholism, which is part of the National Institutes of Health.

In 2021, about 1% of people who had alcohol use disorder said they received medication for it, according to the National Survey on Drug Use and Health. In comparison, 22% of people with opioid use disorder said they received medication treatment.

But there’s evidence medication helps. According to a study published in 2021 the Internatio­nal Journal of Environmen­tal Research and Public Health adults aged 65 and older admitted for alcohol use disorder were less likely than middle-aged and 50-64 year olds to be prescribed naltrexone, one of the drugs approved to treat AUD.

“I think we need to do a better job of identifyin­g older patients and offering them treatment,” said Benjamin Han, a geriatrici­an, addiction medicine physician and researcher at University of California San Diego, who said he offers naltrexone to any patient who meets the criteria for alcohol use disorder.

Despite evidence that naltrexone works, “we’re not using it or offering it to patients,” he said.

Meanwhile, in emergency department­s, data shows physicians are slightly more likely to screen for excessive alcohol use, with one in six doing so consistent­ly. But less than half used that informatio­n to provide interventi­ons, like medication assisted treatment.

“It would be like having somebody come in with diabetes and not offering them insulin on discharge,” said Cara Poland, an internal medicine doctor and associate professor at Michigan State University.

Part of the problem, she said, is that medical schools struggle to incorporat­e addiction treatment into their curricula.

Poland leads a program called MI CARES that aims to prepare students for residencie­s by incorporat­ing SUD training into all four years of medical school, including through introducin­g them to people in recovery. The curriculum includes a section on older adults to teach students how substance use disorders present differentl­y in that population.

The goal, she said, is to “get them to the point where they’re kind of questionin­g some of the things that they hear on rotations.”

While Congress has focused in recent years on the drug overdose epidemic, which killed 107,000 people in 2021, advocates have pushed for more attention on alcohol, which contribute­s to the deaths of 140,000 people every year. Alcohol is the number one substance used by older adults, and costs society about $249 billion every year, according to a CDC estimate.

“If we could fix this challenge, we would probably save an enormous amount of money in health care costs,” Koob said. “But it’s something that’s often overlooked.”

Federal grants aim to train the health care workforce and fill in the gaps in access to care for behavioral and mental health services, particular­ly for population­s that might not otherwise get that care.

Grant funding primarily comes from SAMHSA, which had a $6.4 billion discretion­ary budget in 2022.

But while federal grants for treating opioid use disorder are widely available, funding for programs focused specifical­ly on alcohol use disorder and older adults can be hard for nonprofits to find.

SAMHSA doesn’t have any grants currently awarded to organizati­ons focusing on alcohol use and older adults, a spokespers­on said, despite the growing need for services in that population and lackluster coverage of those services by Medicare.

“If more money were allocated to help clinics across the nation work with older adults who struggle with substance use disorder, that would be extremely helpful,” MacFarland said.

SAMHSA is currently accepting applicatio­ns for a $1.5 million program that would provide training, guidance and mentoring on the use of medication­s for alcohol use disorder. But it doesn’t target a specific population.

“SAMHSA needs to be required to include older adults in their funding stream,” said Emery-Tiburcio of Rush.

The focus has primarily been on opioids.

State Opioid Response Grants, created by Congress in 2018, have become one of the main funding sources for providers helping with substance use disorders, totaling more than $1 billion in funding each year. The Government Accountabi­lity Office has found that some states can’t spend all the money they are awarded, partly because it is limited for treatment of OUD and stimulants.

Some advocates have asked Congress to broaden eligibilit­y for the grants to include alcohol; Congress recently expanded eligibilit­y to treatment of stimulants like meth and cocaine.

“Alcohol Use Disorder appears to be overlooked,” Appalachia­n Recovery Alliance in West Virginia, a coalition of providers treating substance use disorders, wrote in a March letter to Democratic Sen. Joe Manchin III. “Unlike socalled ‘hard’ drugs, immoderate drinking — the kind of drinking that can kill — is normalized in our culture.”

 ?? DREAMSTIME ?? According to the 2021 National Survey on Drug Use and Health, 7.6% of adults 50 and older had an alcohol use disorder in the past year — a lower rate than other adult age groups, but one that, like other adult age groups, has increased in recent years.
DREAMSTIME According to the 2021 National Survey on Drug Use and Health, 7.6% of adults 50 and older had an alcohol use disorder in the past year — a lower rate than other adult age groups, but one that, like other adult age groups, has increased in recent years.

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