Common substance use disorders in older adults

Seim, Lynsey A.; Vijapura, Priyanka; Pagali, Sandeep R.; Burton, M. Caroline

doi:10.1080/21548331.2020.1733287

Cited by 14 publications

(10 citation statements)

References 55 publications

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“…Several studies have shown increasing rates of CLD in younger individuals and the baby boomer generation ( 1 , 12 , 15 ). Furthermore, SUD prevalence in younger Americans is rising as a consequence of the opioid epidemic ( 34 , 35 ) and in older adults as the baby boomer generation ages ( 11 , 36 ). Changes in the age distribution can influence treatment and intervention programs as well as public health response, given the inherent differences in the psychosocial and medical needs of these different age groups.…”

Section: Discussionmentioning

confidence: 99%

Contemporary Trends in Hospitalizations for Comorbid Chronic Liver Disease and Substance Use Disorders

Desai

Greene

Nephew

et al. 2021

Clin Transl Gastroenterol

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INTRODUCTION: Chronic liver diseases (CLDs) and substance use disorders (SUDs) are increasingly prevalent and often coexist. Contemporary studies describing the characteristics and hospitalization trends of those with comorbid CLD-SUD are lacking. We aimed to characterize a population-based cohort with comorbid CLD-SUD and describe trends in these hospitalizations over time by individual-level characteristics. METHODS: We performed a cross-sectional analysis of the National Inpatient Sample from 2005 through 2017. Diagnosis codes were used to identify adult hospitalizations with CLD, SUD, or both. Bivariate and multivariate analyses were used to make comparisons between diagnosis categories. Unadjusted and age-adjusted trends in these hospitalizations were described over time. RESULTS: Of 401,867,749 adult hospital discharges, 3.2% had CLD-only and 1.7% had comorbid CLD-SUD. Compared with CLD-only, comorbid CLD-SUD hospitalizations resulted in higher inpatient mortality (3.1% vs 2.4%, P < 0.001) and were associated with younger age, male sex, Native American race, and urban and Western US location. Over time, comorbid hospitalizations grew 34%, and the demographics shifted with larger increases in hospitalization rates seen in younger individuals, women, Native Americans, and those publicly insured. In comorbid hospitalizations, alcoholic SUD and CLD decreased, but drug SUDs and nonalcoholic fatty liver diseases are fast-growing contributors. DISCUSSION: In this comprehensive analysis of US hospitalizations, comorbid CLD-SUD hospitalizations are increasing over time and lead to higher inpatient mortality than CLD alone. We further characterize the changing demographics of these hospitalizations, providing a contemporary yet inclusive look at comorbid CLD-SUD hospitalizations. These data can guide interventions needed to improve the poor outcomes suffered by this growing population.

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Section: Discussionmentioning

confidence: 99%

Contemporary Trends in Hospitalizations for Comorbid Chronic Liver Disease and Substance Use Disorders

Desai

Greene

Nephew

et al. 2021

Clin Transl Gastroenterol

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“…9 Intoxication with alcohol and/or other substances should therefore be considered in the differential of agitation. 10…”

Section: Causes Of Agitation In Older Adultsmentioning

confidence: 99%

“…Intoxication with alcohol is common among older adults with 9% qualifying as binge drinkers and 2% as heavy drinkers 9 . Intoxication with alcohol and/or other substances should therefore be considered in the differential of agitation 10 …”

Section: Causes Of Agitation In Older Adultsmentioning

confidence: 99%

The agitated older adult in the emergency department: a narrative review of common causes and management strategies

et al. 2020

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Agitation and aggression are common in older emergency department (ED) patients, can impede the expedient diagnosis of potentially life‐threatening conditions, and can adversely impact ED functioning and efficiency. Agitation and aggression in older adults may be due to multiple causes, but chief among them are primary psychiatric disorders, substance use, hyperactive delirium, and symptoms of dementia. Understanding the etiology of agitation in an older adult is critical to proper management. Effective non‐pharmacologic modalities are available for the management of mild to moderate agitation and aggression in patients with dementia. Pharmacologic management is indicated for agitation related to a psychiatric condition, severe agitation where a patient is at risk to harm self or others, and to facilitate time‐sensitive diagnostic imaging, procedures, and treatment. Emergency physicians have several pharmacologic agents at their disposal, including opioid and non‐opioid analgesics, antipsychotics, benzodiazepines, ketamine, and combination agents. Emergency physicians should be familiar with geriatric‐specific dosing, contraindications, and common adverse effects of these agents. This review article discusses the common causes and non‐pharmacologic and pharmacologic management of agitation in older adults, with a specific focus on dementia, delirium, and pain.

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“…16 , 17 In addition, the present generation of older adults uses substances at higher rates than previous generations. 4 , 18 The higher prevalence may contribute to opioid overdose deaths in older adults in combination with physical changes associated with aging. 4 …”

Section: Introductionmentioning

confidence: 99%

“…16,17 In addition, the present generation of older adults uses substances at higher rates than previous generations. 4,18 The higher prevalence may contribute to opioid overdose deaths in older adults in combination with physical changes associated with aging. 4 In general, during the last 20 years, men have consistently had higher rates of opioid overdose deaths compared with women.…”

Section: Introductionmentioning

confidence: 99%

Disparities by Sex and Race and Ethnicity in Death Rates Due to Opioid Overdose Among Adults 55 Years or Older, 1999 to 2019

et al. 2022

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IMPORTANCERates of opioid overdose deaths are increasing for older adults. Less is known about these deaths compared with those of younger adults. OBJECTIVE To analyze rate variation among opioid overdose deaths in older adults by sex and by race and ethnicity over time. DESIGN, SETTING, AND PARTICIPANTS This 21-year longitudinal cross-sectional study of adults who died due to opioid overdose at 55 years or older stratified by sex and by race and ethnicity used data from the Multiple Cause of Death database from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research. The data include all opioid overdose deaths among this age group that occurred between January 1, 1999, and December 31, 2019 (N = 79 893). EXPOSURES Sex and racial and ethnic groups. MAIN OUTCOMES AND MEASURES Rates of opioid overdose deaths per 100 000 population by sex and by race and ethnicity for persons 55 years or older. RESULTS During the period 1999 to 2019, 79 893 US residents 55 years or older died due to an opioid overdose. Among these individuals, 79.97% were aged 55 to 64 years, and 58.98% were men. Annual numbers of deaths increased over time from 518 in 1999 to 10 292 in 2019. Annual rates of opioid overdose deaths per 100 000 persons 55 years or older increased over time and ranged from 0.90 in 1999 to 10.70 in 2019. Substantial variation by sex and by race and ethnicity was found. In 2013, rates among non-Hispanic Black men began to diverge from those of other demographic subgroups. By 2019, the opioid overdose fatality rate among non-Hispanic Black men 55 years or older was 40.03 per 100 000 population, 4 times greater than the overall opioid overdose fatality rate of 10.70 per 100 000 for persons of the same age. CONCLUSIONS AND RELEVANCEIn this longitudinal cross-sectional study of US adults who died due to opioid overdose, the burden of opioid overdose deaths among older adults since 2013 was most concentrated among non-Hispanic Black men. Deaths among non-Hispanic Black men were disproportionality represented in the overall increase in the rate of opioid overdose deaths among older adults. Further research is needed to inform policy and practice.

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Common substance use disorders in older adults

Cited by 14 publications

References 55 publications

Contemporary Trends in Hospitalizations for Comorbid Chronic Liver Disease and Substance Use Disorders

Contemporary Trends in Hospitalizations for Comorbid Chronic Liver Disease and Substance Use Disorders

The agitated older adult in the emergency department: a narrative review of common causes and management strategies

Disparities by Sex and Race and Ethnicity in Death Rates Due to Opioid Overdose Among Adults 55 Years or Older, 1999 to 2019

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