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Opioid misuse sending more older adults to emergency departments, study finds

More older adults in the ED is a bad sign for patients but also for providers, who often struggle with costs and utilization.

Jeff Lagasse, Associate Editor

Emergency department visits by people age 65 and older who were identified with opioid misuse and dependence more than tripled between 2006 and 2014, according to new research published by researchers at Towson University.

The study also discovered that opioid misuse was associated with an increased number of chronic conditions, greater injury risk, and higher rates of alcohol dependence and mental health diagnoses.

More older adults in the ED is a bad sign for patients but also for providers, who often struggle with costs and utilization.

These outcomes are reported in the article "Increasing Rates of Opioid Misuse Among Older Adults Visiting Emergency Departments" appearing in the journal Innovation in Aging from The Gerontological Society of America.

IMPACT

National estimates of ED visits indicate that older adults are increasingly struggling with opioid misuse disorders, with increases in population ED visit rates mirroring or exceeding reported rates for younger patients.

A subset of the older patients affected by this may have limited resources to respond to their treatment needs, given broader policies in place that limit access to long-term treatment, the authors said.

From a policy perspective, the findings highlight the importance of the ED in identifying opioid misuse among older adults, especially in light of study estimates suggesting that, nationally, 6.4 older adults with opioid misuse disorder visit the ED every hour, with more than half of these visits resulting in hospitalization.

The findings also point to the challenge of mounting an appropriate, well-informed and targeted response to the problem. For example, although opioid misuse is often construed as unintentional and less common among older adults, there are two important aspects to consider: unintended, relatively new patterns of opioid misuse among older adults as well as those with a longer history of substance misuse disorders

THE TREND

The damage done to America's health by the opioid epidemic is well-recognized and enormous, with drug overdose death rates helping to drive down U.S. life expectancy in recent years. Yet as the problem has worsened, hospitals collectively have seen a loss of programs dealing with substance abuse.

While some hospitals have added programs in recent years, a greater number discontinued them. In 2010, a total of 334 hospitals surveyed offered inpatient services and 588 offered outpatient services, but by 2015 these numbers had dropped to 327 and 577, respectively.

Just today, America's Health Insurance Providers released strategies it felt would be effective in combating the opioid epidemic, focusing on managing chronic low back pain without opioids and increasing treatment of substance use disorder.

"These two areas are critically important to address opioid abuse and offer real opportunities for collaboration and improvement," said AHIP. "Chronic low back pain is often treated with prescription opioids, despite the potential risk and evidence this is may not be effective.

"There is also a need to expand access to SUD treatment -- including medication assisted treatment (MAT) -- because some patients and care providers may not be aware of the options available. However, there is a documented shortage of behavioral health clinicians who can provide this treatment and an immature quality infrastructure for treatment programs."

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com

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