Alcohol and Prescription Drug Use in Older Adulthood

Substance abuse, specifically alcohol and prescription drug use, is one of the most rapidly growing healthcare problem for older adults, 60 years of age and older in Canada and the United States. Researchers project a 3-fold increase in substance abuse in adults aged 50 and older by 2020. Consequently, an estimated 5 million older adults will require treatment for substance abuse problems in the near future. Researchers are only beginning to recognize the prevalence of substance abuse among people age 60 years of age and older as alcohol and prescription drug use in older adults was seldom discussed until recently.

Substance use and misuse place older adults at risk for a variety of possible clinical dangers, contributing to increased use of healthcare resources and a need for age-specific interventions with the increased proportion of older adults living in North American society. Presently, the misuse of prescription and over-the-counter medications is recognized as a problem.

Alcoholism-Disease-Or-Not2However, baby boomers are expected to have had more contact with illicit substances (ie. marijuana, hashish, cocaine (including crack), inhalants, hallucinogens, heroin and prescription-type drugs used non-medically) than past and present cohorts of older adults. Illicit drugs may also be increasing in a small percentage of older adults.

The National Survey on Drug Use and Health reported that illicit drug use by adults 55 to 59 has increased from 1.9% in 2002 to 5.0% in 2008, which depicts the potential for growth in illicit drug use in the baby boomer cohort. However, illicit drug use in older adults is typically linked to individuals who are lifelong drug users.

In addition, approximately 15% of individuals 65 years of age and older living in the community are at risk for alcohol abuse or dependence and 50% of individuals living in personal care homes drink moderately or are dependent on alcohol. However, only 90% of individuals who are at risk for alcohol abuse or dependence do not receive alcohol treatment services.

Therefore substance abuse services in the future will need to anticipate and acknowledge problems with the use and misuse of both licit and illicit substances in older adulthood. However, due to insufficient knowledge, limited research data, and limited and rushed healthcare visits and appointments, healthcare providers often overlook substance abuse and misuse among older adults. Therefore, despite the number of older adults experiencing problems related to substance use, the situation remains underestimated, underidentified, underdiagnosed and undertreated.

The reasons for the inability to acknowledge substance use problems in older adults are due to many factors. First, healthcare providers often overlook substance abuse and misuse among older individuals, as their symptoms are often mistaken for depression, dementia and health problems common to old age such as falling, infections or digestive difficulties. Second, older adults may also hide their substance use and are less likely to seek help for their problems with substance use. Third, many family members of older adults with substance use, particularly adult children, are often embarrassed of their family members’ problems which often results in their inability to seek treatment.

As a result, thousands of older adults who need treatment never go, and the number of substance abusers among older adults continue to rise. Healthcare professionals must acknowledge that older adults’ struggles with substance abuse are becoming a prevalent issue and the stigma associated with these issues must be addressed as well.

Healthcare professionals must acknowledge that older adults’ struggles with substance abuse are becoming a prevalent issue and the stigma associated with these issues must be addressed as well. Mental health practitioners should also receive specific training and education to develop sensitivity towards these issues.

The Role of Marijuana in The Baby Boomer’s Revolution

Baby boomers, born between 1946 and 1964, lived in an era where experimentation with drug use was encouraged. The children of the 1960s who rocked out to the Grateful Dead, Janis Joplin, and The Who, stood up for what they believed in and protested the Vietnam War, and joined the Summer of Love in Haight-Ashbury were part of the cultural revolution of the 1960s. Now, the 1960s “wild child” has aged, and this age cohort is part of a new revolution—the baby boomer’s revolution.

marijuana-1The baby boomer’s revolution refuses to become “elderly”; they refuse to be frail, isolated, or lonely.  They refuse to have someone tell them they must grow old. Their ways are not changing, and they are living out their life as they always have…with continued drug use.

The baby boomers lived during a time in United States history when popular culture accepted substance use. The popular culture of the 1960s -1970s has resulted in the majority of this age group having been exposed to substances at rates unlike any other age group. Marijuana use has increased among baby boomers over the past decade. From 2002 to 2012, marijuana use increased from 4.3% to 8% among boomers aged 50-54, 1.6% to 7.4% among boomers aged 55-59, and from 2.4% to 4.4% among individuals aged 60-64.

The legalization of marijuana supports the baby boomer’s revolution. We are beginning to see how this group is redefining what it means to be old, but what will the new elderly look like?

Research indicates that 62% of all adults over the age of 65 have several chronic conditions, and in fact, 23% of Medicare recipients have five or more chronic conditions. These chronic conditions, combined with substance use may complicate treatment or result in poor treatment outcomes.

The National Association of Social Workers states that “social workers’ primary responsibility is to promote the well­being of clients. In general, clients’ interests are primary.” As social workers, where do we stand on this issue? Do we embrace the baby boomer’s revolution? Do we embrace aging with choice, dignity, self-determination and subsequently, substance use? Or do we return to the status quo?

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Does Obamacare Benefit Baby Boomers?

Baby boomers, born between 1946 and 1964, are changing the definition of what it means to grow old. Baby boomers don’t want aging services the same way their parents did, boomers don’t want senior centers and adult day care centers, they want wellness centers and spas. They don’t want to be isolated in nursing homes, they want to live in active communities. They don’t want to stay home and watch Gunsmoke reruns in their moo moo, they want to go out dancing in high heels wearing Gucci. Boomers are spearheading the movement to age in place and our health care policies are following.

Obama_healthcare_signatureThe health home model of service delivery in section 2703 of the Patient Protection and Affordable Care Act is the most recent federal initiative promoting integrated health care and aging in place. The Patient Protection and Affordable Care Act (H. R. 3590) is a federal policy that signed into law by President Obama in 2010, also referred to as Obamacare.

Section 2703 of the Affordable Care Act authorized states to develop a system of coordinated care through a health home. The health home facilitates access and coordination of health services through home health care, including primary health care, behavioral health care, and community-based services for Medicaid recipients with a chronic condition.

Health homes are of particular importance to older adults since the passage of the Affordable Care Act means reducing health disparities for older adults. For example, the barriers that prevent screening and assessment, and treatment among all older adults have a larger greater impact on homebound older adults due to transportation issues, handicapped accessibility, and isolation. Homebound older adults have greater physical health issues, and therefore, seeking treatment for chronic health conditions presents a significant barrier.

The passage of the Affordable Care Act, Obamacare, brought increasing recognition of the need to consider the totality of an individual’s health and health care. This means fostering overall health and wellness by promoting the integration of behavioral health (mental health and substance abuse) and primary health care to increase access to affordable and effective integrated health care, treatment, and recovery support services.  Within this context, now is a perfect opportunity to engage stakeholders and partners to embrace recovery and all of its dimensions.

However, as the baby boomers redefine what it means to be “elderly” or “senior”, what will this new healthcare system look like for older adults? The home health model is an idea that promotes aging in place. It hasn’t been researched fully to know the benefits of this system. More research needs to be done, but what do you think, is the home health model truly of benefit to older Americans?

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Finding the Consumer in the Midst of Medicare

The consumer is often caught in the middle when it comes to a provider presenting a reasonably priced product while striving to stay out of the red.  The American government is no different when it comes to Medicare and its beneficiaries.  The Medicare program provided assistance to over 49,000,000 people in 2012,1 and this number is expected to continue to increase as Baby Boomers become eligible for the federal program.  Our government is currently struggling with how to assess this growing demand with limited financial resources.  In all the budget and deficit debates, it can be easy to forget the most important part of the equation which is the medicare beneficiaries.

Medicare recipients currently pay different premiums for each of the four parts of Medicare.  Most individuals do not pay a monthly premium for Medicare Part A if they or their spouse have paid into the Medicare system via payroll taxes.  Individuals that do not meet this criteria can purchase Part A for $441 per month.

Many people pay the standard premium of $104.90 per month for Part B, but some individual’s will have to pay more if their income from the previous two years is above $85,000.2  Premiums for Parts C and D differ depending on the individual plan that a consumer decides to purchase.  The four parts are designed to offer beneficiaries the most comprehensive insurance program that they can afford.

What if you can’t afford Medicare premiums and deductibles?  Federal assistance, in the form of Medicaid, is available for low-income individuals.  Medicare also has an Extra Help program available to assist with prescription drugs.  Some states also help their Medicare beneficiaries by means of two state programs:  the Medicare Savings Programs pays Part A and Part B deductibles while the State Pharmacy Assistance Program provides financial assistance for prescription drugs.3

Both federal and state governments have options available for Medicare beneficiaries who are limited by their financial resources.  However, the state programs are not offered in every state and some lower-income seniors may still find themselves receiving few health care options while individuals with more money have the ability to pick and choose an insurance plan that best fits their medical needs.  The federal plan that was originally created to help all seniors and other eligible citizens does not help all recipients equally.

Regardless of any underlying inequalities, Medicare is still a more affordable and efficient health insurance provider than many private companies.  In fact, Medicare is viewed quite favorably among the general public.  While more than half of Americans agree that the federal deficit should be corrected with a combination of increased taxes and decreased spending, 58% oppose any spending cuts to Medicare or Social Security.  Three quarters said the deficit could be cut without any major reductions to Medicare.4

The overall general approval of this welfare policy ensures, to a certain degree, that the program will continue to assist the elderly and the disabled in the struggle to have affordable health care.  General opinion also encourages politicians and policy makers to take a more unique approach when considering how to make the program easier on the government’s wallet without directly cutting funds.

Many different ideas are being tossed around in Congress when it comes to making Medicare more affordable.  Some propose adjusting the age requirement from 65 to 67.  Others argue that Medicare should be a means-tested program with higher income individuals testing out.  Some also argue that spending cuts can be removed from the equation all together if the issue of Medicare fraud is thoroughly corrected.  Consumers should expect to hear more about major changes to the Medicare program within the next few months but should not expect to see a decrease in their premiums or deductibles.

Medicare is a complex federal program and this complexity sheds some light onto how challenging it can be for consumers to afford health care in America.  This leads to an interesting debate on how to more effectively serve American citizens.  Should the focus be on reducing Medicare costs or on reducing the cost of health care as a whole?

There is a growing opinion that health care is an overall wasteful, inefficient, and poor quality institution that is in need of reform.  Such a reform could have huge implications for eligible Medicare beneficiaries and other Americans.  Unfortunately, it is much easier for politicians and Congress to discuss how to change Medicare rather than how to improve the entire American health care system.  In the meantime, consumers continue to get caught in the crossfire between the debate over Medicare coverage and Medicare cost.

Photo Credit: Medicare Prospective Payment System

1The Henry J. Kaiser Family Foundation. (2013). Total number of Medicare beneficiaries, 2012. Retrieved from

2Social Security Administration. Social Security Administration, (2012). Medicare premiums: rules for higher-income beneficiaries (SSA Publication No.05-10536). Retrieved from Social Security Administration website:

3Medicare Resource Center. (n.d.). Frequently-asked medicare questions. Retrieved from

4Wessel, D. (2013, January 24). Whose budget fix is more popular?. The Wall Street Journal. Retrieved from

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