Golden Years, Hidden Struggles: Tackling Substance Misuse in Older Adults (AGEM-Sponsored)

Nearly 4.6 million (8%) adults aged 65 or older live with a substance use disorder (SUD), a 17% increase from 2022, according to the 2023 SAMHSA National Survey on Drug Use and Health. Substance misuse in older adults is frequently underrecognized and undertreated, especially in the emergency department (ED), where SUD symptoms are sometimes misattributed to chronic health issues or normal aging. Misuse is particularly dangerous in this population due to aging-related changes like slower metabolism, reduced muscle mass, and increased drug sensitivity. Alcohol is the most commonly abused substance, with approximately 4.6% of older adults reporting alcohol use disorder. Polypharmacy—taking five or more prescription drugs—is also prevalent, raising the risk of prescription drug misuse and harmful drug-drug interactions. This session will address age-specific risk and protective factors for SUD in older adults, as well as evidence-based guidelines for screening, intervention, and referral to treatment, to improve ED care and better address the growing issue of substance misuse in this vulnerable population.

Learning Objectives:

Upon completion of this session, participants should be able to:
  • Describe the scope of substance misuse (including the opioid epidemic) among older adults
  • Discuss age-specific risk and protective factors for substance misuse in aging
  • Review current evidence-based guidelines for screening of substance use disorder in the ED
  • Propose effective interventions and referral to treatment options for older adults with substance misuse in your ED

Presenters:

  • Rachel Michelle Skains, MD, MSPH
  • Lauren A. Walter, MD, MSPH
Authors

  • Rachel Michelle Skains, MD, MSPH

    University of Alabama Medical Center (Birmingham)

    Dr. Rachel Michelle Skains, MD, MSPH is an Assistant Professor in the Department of Emergency Medicine (EM) at the University of Alabama at Birmingham (UAB) with a joint faculty position at the Birmingham VA Medical Center (BVAMC). After graduating from Wake Forest School of Medicine (2016), she completed her EM residency at UAB (2019) followed by a Clinical Research Fellowship focused on Geriatric EM while pursuing a Master of Science in Public Health (MSPH) in Clinical and Translational Science from the UAB School of Public Health (2021). Dr. Skains was awarded the AHRQ NRSA T32 Postdoctoral Scholar Fellowship in the UAB Health Services Research Training Program (2020-2022), in addition to funding through the UAB Integrative Center for Aging Research (ICAR) and Geriatric Emergency care Applied Research (GEAR) 1.0 pilot grant programs. She has recently been awarded two NIA awards: Grants for Early Medical/Surgical Specialists' Transition to Aging Research (GEMSSTAR) R03 (2023-2025) and Exploratory/ Developmental Grant R21 (2023-2025), in addition to the GEMSSTAR for EM Supplemental Funding Program through SAEMF/EMF and UAB Health Services Foundation General Endowment Fund (HSF-GEF) grants. These studies examined the risk of adverse health outcomes, such as delirium, with potentially inappropriate medication use among older adults in the ED. In addition, Dr. Skains was an ED physician champion for the UAB – Highlands and BVAMC Geriatric ED Committees, which received Level 1 (2021) and Level 3 (2023) accreditations respectively, completed the UAB Geriatric Scholar Interprofessional Program (2019-2021), updated the Geriatric ED Guidelines 2.0 in Medication Safety, published the first expert consensus-based list of high-risk prescriptions to avoid for older ED patients (GEMS-Rx), and serves as Member-at-Large for the SAEM Academy of Geriatric Emergency Medicine (AGEM) (2024-2026).

  • Lauren A. Walter, MD, MSPH

    University of Alabama Medical Center (Birmingham)

    Dr. Walter is a 2005 graduate of the University of Michigan Medical School. She completed her emergency medicine residency at the University of Alabama at Birmingham (UAB) in 2009 where she currently remains as an Associate Professor and Associate Vice Chair. In addition, Dr. Walter is currently the Social Emergency Medicine & Population Health Fellowship Director at UAB. Dr. Walter is a clinical researcher with a focus on social emergency medicine and population health. She is PD/PI for several socially-based, funded clinical research programs in her department, including universal HIV and HCV screening as well as opioid use disorder identification and engagement programs. Finally, Dr. Walter is also the current Research Editor for SocialEMpact.com.

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