Drug overdoses have been a subject of research for many years, especially due to the opioid epidemic and a spike in the use of drugs such as fentanyl. While overdose deaths in the general population are beginning to decrease, they are on the rise in older adults – specifically for persons of color. [4] Recent research shows a concerning rise in older adults experiencing overdose deaths linked to fentanyl.
This trend points toward a need for improved management from a behavioral health and medical standpoint. However, addressing these episodes in geriatric individuals is even more nuanced since many age-related and environmental factors can complicate overdose prevention and treatment for this population.
What's driving the surge in fentanyl deaths among older adults
Research has yet to determine an exact cause for the increase in fentanyl-associated overdoses in older adults, though there is likely more than one contributing factor.
Data show that fentanyl overdoses occurring in geriatric individuals are more often attributed to multi-substance use rather than solely fentanyl use. Older adults who overdosed tended to pair stimulants (namely, methamphetamines and cocaine) with fentanyl. [1] Research shows that 18% of senior overdoses were due to a combination of opioids and stimulants, 39% were due to just stimulants, and 57% were due to just opioids. [3]
This combination of drugs is hazardous since they have opposite effects on the body. Fentanyl is an opioid (a central nervous system depressant, also known as a ‘downer’), and stimulants are a type of ‘upper’ that increases central nervous system activity. This mixture places undue pressure on vital organs as the body attempts to balance out the effects of each drug type.
While the rise in these incidents among older adults has been growing for nearly a decade, researchers observed a particularly sharp increase in older adult fentanyl-stimulant overdoses in 2020. This suggests the COVID-19 pandemic may have somehow further added to this trend. [1] In addition to polysubstance use and the risk for drug interactions, other possible contributing factors that could be leading to a rise in fentanyl overdoses among older adults include: [2][5]
- Underdiagnosis of substance use disorders in elderly patients.
- Increased health issues and medical problems, leading to overprescribing of medications.
- Reduced ability of older adults to metabolize drugs, leading to a need for smaller doses.
- Accidental or intentional misuse of prescription medications.
- Untreated depression or other mental illnesses.
- Lifestyle factors, including reduced independence, loneliness, and increased stress.
How fentanyl affects the aging body
While polysubstance use increases the risk of drug-related complications for anyone, this can be especially dangerous in aging individuals due to their slowed metabolisms. This makes overdose more likely for older adults, as their bodies are not able to filter the drugs as quickly as younger individuals can. [5]
In addition, age-related sensory changes can magnify the effects of recreational drugs, leading to effects such as vision changes, balance impairments, and other perceptual changes. [5] This increases their risk of falls and other injuries, which already rises due to age.
The role of health systems and prescribing practices
It is also important to acknowledge the role of overprescribing in the rise of older adult overdoses. Between 1995 and 2010, older adults were prescribed opioid pain medications nine times more often than during the previous time period. [5] Therefore, it is possible that overprescribing may have led many older adults to develop a dependence on opioid medications or even take multiple opioids to address their symptoms.
One study found that nearly 50% of older adults take more than five medications or supplements each day. This places them at risk of a host of side effects as well as adverse drug interactions between both opioid and non-opioid medications. [6]Â
Since then, changes in pain management policies may have led to fewer opioid prescriptions. This may have caused older adults to seek substances through unregulated channels. Geriatric individuals may be less likely to consult their physicians about non-prescribed drug use, therefore leading to mixing certain substances and other unsafe practices, potentially leading to overdose.
Recognizing warning signs of fentanyl exposure in seniors
Older adults can demonstrate several signs that point toward a fentanyl overdose. These include: [7]
- Skin changes, most often discoloration and clamminess.
- Blue fingertips, lips, or pale color.
- Muscle limpness.
- Slow breathing rate with weak and shallow breaths.
- Narrow, small pupils.
- Gurgling or choking sounds.
- Low level of alertness.
- Increased drowsiness and trouble staying awake.
Prevention and treatment solutions
Research shows that substance use disorder (SUD) treatment for older adults is most beneficial when provided over longer periods of time. This applies to both medication management and behavioral therapies.
Integrated intervention models that focus on the comprehensive diagnosis and management of chronic diseases also tend to be more effective for older adults. This reduces the risk of complications and enhances outcomes by taking a more holistic approach. In addition, older adults with SUD benefit from treatment that focuses on care management, eliminating barriers to medical services, and bolstering support networks. [5]
Staff and caregiver training should also be provided on an ongoing basis to ensure the use of evidence-based practice. For example, providers should be aware of differential diagnoses for SUD, including other chronic conditions and certain age-related changes that may mimic overdose signs.
Moving forward: Addressing stigma and support for older adults
Stigma continues to impact widespread prevention and treatment efforts for older adults at risk of substance use disorders. Many people falsely assume that young adults and middle-aged individuals are the groups with the highest overdose rates or that older adults are being more closely monitored by physicians for these concerns.
However, these assumptions lead people (even physicians) to be less aware of warning signs in this population. Physicians may also tend to prescribe opioid medications on the basis that older adults ‘know better’ than to abuse prescription medications or partake in recreational substance use.
One of the best steps forward is to spread awareness about overdoses in this population and work toward developing prevention efforts that cater to older adults’ unique set of needs. Anyone working with these individuals must be educated in best practices as well as fentanyl overdose warning signs to be on the lookout for.
All substance use disorder treatment for older adults should similarly reflect their need for comprehensive intervention focused on care management and addressing multiple chronic conditions in the event they are present.
