Close-up of an elderly man's hands with pills

Opioid Use Disorder in Older Adults

Amy Leslie

For older adults, opioid use disorder (OUD) is a growing problem. Medicare data suggests that, since 2013, the estimated rate of OUD in older adults has increased by more than 300% overall in the U.S.

 Robert Levy, MD
Robert Levy, MD

“There are several factors why the older adult population is particularly at risk for opioid use disorder, including having a higher rate than the general population of experiencing chronic pain and an increased likelihood of being given a prescription for opioids,” said Robert Levy, MD, an associate professor in the UMN Department of Family Medicine and Community Health. “Additionally, emotional and social challenges such as bereavement, retirement, social isolation, functional decline, and institutionalization can be factors that lead to eventual request for or opioid use.”

Working with the Minnesota Northstar Geriatric Workforce Enhancement Program (MN-GWEP), Levy authored MN GWEP’s recently launched Opioid Use Disorder in Older Adults toolkit, which includes a free online interactive module for health professional students to learn how to recognize opioid use disorder and symptoms of withdrawal. The opioid toolkit was peer reviewed by an interprofessional team of experts in aging and is designed to provide educators with resources for teaching aging content. 

“It’s important for health care professionals to be familiar with common signs of OUD in older adults so that, as part of an interprofessional health care team, they can help refer the patient for further assessment or treatment,” said Levy. 

Levy also shares that opioid use disorder affects older adults differently than the younger adult population.

“Older adults typically have altered pharmacodynamics—the effects and actions of drugs—and pharmacokinetics—how drugs move through the body—when compared to the general population because these typically change as adults age,” said Levy. “They are more likely to experience adverse effects from opioid use, including respiratory depression, altered senses that can lead to falls, and those associated with delirium or dementia, anorexia, and trauma, such as hip and spinal fractures or brain bleeds.”

Levy added that older adults may also experience more complicated withdrawal syndromes, and have a higher incidence of falls, cerebrovascular accidents, or heart attacks.

Kristine Talley, PhD, RN, GNP-BC

“Many clinicians do not know how to recognize substance abuse problems, including opioids, but do have responsibility to recognize and refer for treatment. A lot of symptoms of opioid use disorder and withdrawal symptoms can be harder to detect in older people because they may have other conditions that may present with the same symptoms,” said Kristine Talley, PhD, CNP, RN, FGSA, associate professor in the School of Nursing, and co-director of the MN GWEP. “The Opioid Use Disorder in Older Adults toolkit is useful for all health professionals who want to learn to recognize any red flags for opioid use disorder, including the presenting symptom of withdrawal.”

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