Almost 80% of adults aged 65 and older in the US, surveyed between 2001-2002, had used some substance during their lifetimes and more than half reported using some substance in the past year. Combined alcohol and tobacco were by far the most commonly used substances by over the lifetime but alcohol was the most commonly used substance over the past 12-months. Using gender specific definitions of moderate and heavy drinking, most older adults who drank alcohol were light or moderate drinkers, but more than 10% were heavy drinkers. Fewer than 5% of older adults reported ever having engaged in non-medical use of drugs or used any other combination of substances other than alcohol and tobacco.
These data are consistent with others’ findings of the prevalence of substance use in older populations;1-5,14-16, 25-27
and highlight that, for this generation, alcohol is the substance of choice for older adults, followed by tobacco. The National Survey on Drug Use and Health (NSDUH), 200215
is comparable to 2001-2002 NESARC. Both of these surveys collected data from a nationally representative sample on overall substance use patterns and correlates. Data from NSDUH, 2002 reveal that, among the sample of 2,019 adults aged 65 years and older, lifetime and past year alcohol use was reported to be 78% and 50% respectively, tobacco use was 70% and 16%, and illicit drug was use 9.2 and 1.3%. These rates are similar but higher than those observed in NESARC. The discrepancies between the two data sets have been attributed to factors related to privacy and anonymity since NSDUH data were collected by a private firm using computerized self-administration methods and names were not recorded or linked with respondents’ answers while NESARC data were collected by the US Census Bureau using face-to-face interviews and was not anonymous.26
Use of alcohol may have benefits or risks depending on the amount consumed, the presence of comorbidities, and the use of medications.7
While most older adults who consume alcohol do so in amounts that are unlikely to cause harm and likely to be beneficial, a significant minority drink more than is recommended7,25
and/or have comorbid conditions or take medications that may increase risk for harm.8
Up to one or two standard drinks per day is generally considered a safe limit of drinking for adults including those aged 65 years and older.1,23
But for those who have comorbidities (e.g., dementia) and symptoms (e.g., insomnia) that could be worsened by alcohol or those who take medications that may interact negatively with alcohol (e.g., sedatives) or be less efficacious with alcohol (e.g., antidepressants), even 1-2 drinks per day may be hazardous.7,8
Tobacco use declines over the lifetime among those who survive to older age but continued use increases risk for harm3
and the combined use of tobacco and alcohol increases risks more than use of either alone.13
Non-medical use of drugs is rare among older adults, possibly because of rare exposure to these drugs in their youths,27
high mortality rates associated with illicit drug use,17
and easy access to many psychoactive drugs (e.g. sedatives and opioids) with a physician’s prescription.19
Indeed, older adults are the age group most commonly prescribed psychoactive drugs. Aside from the less than 0.1% of older adults who reported cannabis use, the only drugs this population reported having used in the past 12-months were sedatives, tranquilizers and opioids. Though older adults may use these drugs in ways not prescribed by the physician, because they obtain them with a physician’s prescription, they may not view their use of such drugs as “non-medical”.
Among this group of adults aged 65 years and older, the use of alcohol and tobacco was more likely among those who were younger and male, and divorced or separated, compared to older age groups, females, and married persons. In contrast, those who were married, more highly educated, had higher income, and those with better-perceived current health were more likely to use alcohol but less likely to use tobacco in the past 12-months compared to those who were widowed, less educated, had lower income, and had worse health. Use of alcohol and tobacco have been observed among those with these demographic and health-related characteristics in a variety of studies,1,3,28,29
and illustrate that current alcohol use is associated with better socioeconomic and health status while current tobacco use is associated with lower socioeconomic status and worse health status. These data are also consistent with others’ findings that men and younger persons consistently use substances more than women and older persons in both younger and older populations.1-3,21,25,28,29
For example, using 2000 NHIS data, past year drinking was reported among those aged 65-69, by 55.7% of men and 45.1% of women and among those aged 80-84 years, by 44.5% of men and 29.2% of women.25
We observed few sociodemographic correlates of non-medical drug use. Using NESARC data, others have observed that younger persons, men and Whites engage in non-medical use of drugs more than older persons, women, and non-Whites.2,4
While we also found that younger persons and men had higher odds of lifetime non-medical drug use, compared to older persons and women, we did not observe such associations for past 12-month non-medical drug use. The numbers of those who engaged in non-medical drug use were quite small, particularly among those who reported such use in the past 12-months. The power to evaluate associations of non-medical drug use and sociodemographic and health-related correlates among older adults will increase as the Baby Boomer generation ages and the numbers of persons reporting engaging in non-medical use of drugs, including prescription and illicit drugs, increases.9
Aside from the relatively small sample of those engaging in non-medical drug use, limitations of this study include the possibility that rates of all three substances used among this older cohort may be lower than expected because of premature mortality among those who were heavy substance users. Recall bias and social undesirability of substance use, particularly for women, may have also contributed to underreporting. The cross-sectional design is another limitation but data from the 3-year follow-up of NESARC participants will enable us to look at longitudinal patterns and sociodemographic correlates of substance use in older adults in future investigations.
In summary, these data from NESARC, one of the largest population-based studies of older adults’ substance use available, add to our knowledge of alcohol, tobacco and non-medical drug use in the growing population of older adults in the United States and suggest that health care providers should ask about alcohol and tobacco and non-medical drug use regularly to identify those who may be using these substances. While any amount of tobacco use is harmful, alcohol use may have risks or benefits depending on the amount and pattern of use, comorbid conditions and medications used. The extent of non-medical drug use in this age group is not yet clear but is likely to be more common than the rare use identified in NESARC especially given the expected rise in such drug use in the Baby Boomer generation and the extensive use of psychoactive drugs in older adults. Because of the risks associated with psychoactive drugs, particularly those with abuse potential, it is prudent for health care providers to ask their patients who are using these medications about the amount and patterns of use as well as symptoms and signs (e.g., confusion, unsteady gait) that may indicate increased risk for harm. Future exploration of NESARC data will improve our understanding of the mental health correlates of substance use and longitudinal patterns and predictors of substance use among older adults. Such information will help to target screening and intervention efforts to reduce hazardous substance use in older adults as well as to better understand the benefits of moderate alcohol use.