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Breaking the Silence: Substance Use Among Older Adults · Talking FACS

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  Welcome to Talking FACS, what you need to know about family,
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  I bet if the only thing I said was, today on Talking FACS, we're going to talk
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  about about binge drinking and substance use, the first thought to run through
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  your mind would probably be that we are talking about college kids.
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  But in reality, my guest, Dr. Alex Elswick, Assistant Extension Professor for
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  Substance Use Prevention and Recovery, is here to discuss substance use and misuse in older adults.
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  I am your host, Mindy McCulley, Extension Specialist for instructional support.
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  Welcome, Alex. Hi, Mindy.
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  So why are we talking about substance use and older adults now?
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  This is starting to step on my toes just a little bit.
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  Hitting a little close to home, is it? Just a little bit.
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  I think, yeah, why now is your question. And the answer would be because older
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  adults are a rapidly growing group of people. Right.
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  By 2050, the estimate is there will be nearly a million Kentuckians,
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  for instance, who are 65 and older.
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  Okay. has to do with those baby boomers. Which I'm not one.
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  Correct. And I knew that. I'm younger than them. Really over the last 20 years,
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  we've seen alcohol use increase among older adults.
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  And that's in particular, some at-risk or hazardous drinking behaviors.
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  So like binge drinking in particular and things like that.
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  Right. Okay. Let's first just define what binge drinking is.
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  Because that might be something that people are doing and not realize that they're doing.
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  I think you're exactly right. It's a good question. And I think it frequently
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  surprises people how low the threshold can be.
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  So it's gender dependent for women, four or more drinks in a sitting and for
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  men, five or more drinks on one occasion, which when you think about it,
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  it sounds like a lot sort of when you say it like that.
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  But when you think about going to an event like Keeneland, when you think about
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  going to a football game, something that might last three or four hours.
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  That's not uncommon, really, that binge drinks like that.
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  And so in terms of what the statistics show, binge drinking and heavy drinking
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  are up 22% for the older adult population.
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  Pretty substantial, isn't it? It is. Almost a fifth of the population,
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  well, a little bit more than the fifth of the population. Right.
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  So for added context, about 62% of older adults drink alcohol.
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  And that's actually roughly consistent with the percentage of just adults in
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  the United States in general who drink alcohol.
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  And I always think it's worth pointing out that alcohol is a drug.
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  And that means that most adults in the United States use drugs.
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  It's like uncomfortable. People like bristle when you say that,
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  but it's just a matter of fact. Alcohol is a drug.
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  Most people in the United States use drugs. So you start there.
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  And then so 62% of older adults drink alcohol, about 17% binge drink,
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  and about 7% have a diagnosed alcohol use disorder.
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  Although I would say this, we know that substance use disorders are underdiagnosed
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  and probably substance use disorder among older adults is in particular underdiagnosed
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  for a variety of reasons.
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  One just being stigma, people a lot less likely to admit at 60,
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  70, 80, you know, that they have an alcohol use disorder.
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  And probably when you go to get your annual physical and they say, do you drink alcohol?
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  And you say, yes. And they say, how frequently?
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  Yes. Most often, it's probably underreported because that's a self-report.
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  That's exactly right. People frequently underreport. There's plenty of research
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  on that, that people with substance use disorders underreport their substance use.
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  And there are a lot of barriers in those clinical settings, too.
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  I'm fortunate to be working on some research with Dr. Kerbis and Dr.
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  Amy Kostelic here at UK, our gerontologists.
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  And there are a variety of those clinical barriers.
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  So for instance, like a lot of providers don't even want to screen for alcohol
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  use disorder because they don't really feel confident in what to do.
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  Like, I don't really know how to respond. I don't have specialized training for addiction.
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  So I don't want to discover there's a problem if I don't have a solution to
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  offer someone, you know? And so sometimes that screening doesn't happen.
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  And then when you combine it with the underreporting, yeah, it's very much overlooked
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  and underdiagnosed and it's a growing problem. Why is this growing problem such a complex issue?
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  There's really a lot of factors associated with aging that exacerbate the potential
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  harms of drug use and actually of alcohol in particular.
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  So like, you know, physiological changes, just like you can't run as fast as
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  you used to because those muscles and those organs aren't working as well.
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  You know, it's true when it comes to the way that your body metabolizes and
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  detoxifies, substances.
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  So your liver is not able to metabolize alcohol as effectively,
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  which means less alcohol can lead to greater intoxication or greater harm.
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  We also know that in general, older adults tend to have more disability,
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  which is associated with a greater number of prescriptions.
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  Some recent data we found about 87% of older adults have at least one prescription
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  and 36%, so more than a third of older adults, have five or more prescriptions.
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  So there could be any number of interactions between and among those substances
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  with alcohol and other drugs.
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  And then more specifically, we know that older adults are more likely to have
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  a prescription for opioids, which has a really harmful synergistic effect with alcohol.
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  So it's unfortunately a lot of the realities of our mortality and of our aging
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  that make our body a little less able to withstand the potential harms of drugs.
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  And I was just talking to Dr. Heather Norman Bergdorf about supplements,
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  and I'm guessing that a lot of older adults also take supplements,
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  which might have a significant impact when interacting with alcohol as well, I would guess.
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  I think that's exactly right. And many people either ignore warnings not to
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  mix alcohol with prescription medications or are really unaware and unaware
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  that that really presents a potential risk.
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  And there are lots of other health-related morbidities.
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  Older adults are already at increased risk of experiencing a fall, for instance.
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  And so when you combine potential intoxication with increased risk of falling, that's very dangerous.
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  It's actually just worth mentioning that falls represent a surprising proportion
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  of the amount of accidental harm caused by alcohol use. It's really not uncommon.
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  So there are just a litany of factors that makes aging kind of unkind to the
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  body and harsh to interactions with substances.
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  So what specific barriers do older adults face when we look at substance use or alcohol use?
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  Yeah, there are many. So in addition to facing all of the barriers that we would talk about,
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  any adult facing to accessing treatment or accessing care, in particular older,
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  like stigma, We know that stigma limits everyone's access to care,
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  but specifically for older adults, research suggests there might be a greater
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  degree of stigma, and that could
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  be, number one, due to just generational attitudes towards substance use.
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  Older adults might have generally a less permissive attitude towards substance
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  use or alcohol use, which may make them less likely to identify that they have
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  a problem, less willing to admit that they have a problem,
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  certainly less willing to admit it out loud, and then less able to derive support.
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  They may also experience stigma from providers who, when we have this really
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  stigmatized picture of a person who's addicted to drugs or alcohol looking a
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  certain way, it most often, it's not an older adult in our mind.
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  And so for a lot of providers, because of that implicit bias,
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  it can be harder for them to identify substance use problems in older adults.
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  In addition to those things, there are all these social factors.
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  Older adults experience a lot of isolation, a lot of loneliness,
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  which I think Dr.Kostelic could talk endlessly about.
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  You know, the way that complicates not just emotional support and social support,
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  but even just forms of tangible support, like getting a ride to a clinic to
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  get access to medical care and things like that.
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  So what can we do to better help these older adults who are using substances?
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  Great question. I think the most important thing we can do is reduce stigma.
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  And it seems to be a particularly important intervention for older adults because
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  they may have more stigmatized attitudes towards drugs and drug use.
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  So it's really about talking about it in order to de-stigmatize it,
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  sharing the facts, educating people about safer alcohol use.
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  Not at all because we want to promote any kind of substance use,
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  but because we want to promote safer substance use.
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  We want older adults to be in a position to reduce harm.
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  So whether that's teaching them about standard drink sizes or teaching them
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  about ways to mitigate harms associated with drugs and alcohol,
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  things like don't mix it with your prescriptions.
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  And alternate water with alcohol, the same things that we would say to young people.
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  Yeah, yeah. Just read your labels on your prescriptions. Usually they say, don't mix, right?
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  They do. That's exactly right. And one other thing just worth mentioning,
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  speaking of labels and speaking of alcohol and older adults and chronic disability,
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  mixing all those things together,
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  the Surgeon General has recently been making a push to put a label.
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  You know, the black label on cigarettes that identifies them as carcinogenic?
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  The Surgeon General is making a push to do the same for alcohol.
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  Because for a long, long time, decades and decades, we've had really convincing
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  research that shows that alcohol is a carcinogen.
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  But for a variety of complicated reasons, we haven't gotten that public health message out there.
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  So it's worth mentioning that even though we defined binge drinking as four
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  or five drinks in an occasion, any amount of alcohol is considered harmful.
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  And any amount of alcohol use increases the risk of cancer later in life.
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  That is fabulous information to know.
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  It is, isn't it? Maybe we'll do an entire podcast on alcohol as a carcinogen. We definitely should.
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  Alex, thank you so much for always sharing such cutting-edge information with
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  our listeners. Yes, thank you for your time.
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