By Jacqueline Howard, CNN
Deaths related to drug misuse and alcohol abuse appear to be on the rise among older adults in the United States, similar to the recent increases seen among younger adults, according to two new reports from the US Centers for Disease Control and Prevention.
Rates of deaths from drug overdoses among seniors have more than tripled in the past two decades, according to one report published Wednesday by the CDC’s National Center for Health Statistics. In 2020, more than 5,000 adults 65 and older in the United States died of a drug overdose.
Though drug overdose death rates for older adults tend to be lower than for other age groups — and made up just 0.2% of total deaths among adults 65 and older in 2020 — such deaths have been climbing. Between 2000 and 2020, the rates rose from 2.4 to 8.8 deaths per 100,000 people among adults 65 and older.
Another new report from the National Center for Health Statistics finds that rates of alcohol-induced deaths among adults 65 and older have been climbing since 2011 and rose more than 18% from 2019 to 2020. In 2020, more than 11,000 older adults died of alcohol-induced causes.
“It’s important to describe changes in these causes of death for all ages, including the older population,” Ellen Kramarow, an author of the new reports and health statistician at the National Center for Health Statistics, said in an email to CNN.
Although Kramarow and her colleagues did not analyze what factors could be driving these increases, she said that “it’s not unreasonable to think that the forces affecting younger people also affect people 65 and older.”
Drug overdose deaths in the United States hit the highest level on record last year, according to provisional data from the CDC. Overdose deaths have been on the rise for years in the US but surged amid the Covid-19 pandemic, with some experts citing mental and financial stressors as factors behind the rise.
Drug, alcohol death rates in older adults
The report on drug overdose deaths, based on data from the CDC’s National Vital Statistics System, found that death rates in 2020 involving opioids were highest when they specifically involved synthetic opioids other than methadone, such as tramadol or fentanyl.
Fentanyl is so powerful that it is up to 100 times more potent than morphine. From 2019 to 2020, death rates from these synthetic opioids increased 53% among older adults, rising from 1.9 to 2.9 deaths per 100,000 people.
Between 2000 and 2020, drug overdose deaths increased more among men than women, rising from 2.7 to 12.3 deaths per 100,000 men compared with 2.3 to 5.8 per 100,000 women. The data also showed some racial differences, suggesting that in both 2019 and 2020, non-Hispanic Black men 65 and older had higher drug overdose death rates than White and Hispanic men. And Black women ages 65 to 74 had the highest drug overdose death rates, but among women 75 and older, White women had the highest.
The report on alcohol-induced deaths, based on CDC data, found that although they make up less than 1% of all deaths among adults 65 and older, the death rates increased between 2019 and 2020, climbing from 17 to 20.1 deaths per 100,000 people.
Men had higher rates of alcohol-induced deaths. Between 2019 and 2020, among men ages 65 to 74, the rate increased from 36.5 to 43.4 per 100,000, and for men 75 and older, rates increased from 19.8 to 21.5, according to the report.
As for women, alcohol-induced death rates increased from 10.2 to 12.9 for those ages 65 to 74 and from 4.4 to 5.3 for those 75 and older.
This data also showed some racial differences, suggesting that alcohol-induced death rates in adults 65 and older were highest for American Indian or Alaska Native adults, followed by Hispanic, White, Black, and Asian adults.
Excessive drinking can have more severe consequences for the body in older age than for younger adults, leading to a higher risk of death, said Peter Hendricks, a professor at the University of Alabama at Birmingham School of Public Health Department of Health Behavior.
“As we get older, the way that we metabolize drugs changes, and as a consequence, the effects of alcohol differ as we age,” said Hendricks, who was not involved in the new reports. “For many people, what may have been a reasonable or moderate degree of alcohol consumption at some point in the past is now enough to result in significant intoxication or inebriation.”
For example, if an older adult is at home and has had too much to drink, they are at higher risk of falling, according to Hendricks.
“The risk of falls, motor vehicle accidents and other types of accidents increases as you get older due to age-related changes in motor coordination,” he said. “What might be considered ‘casual’ alcohol consumption could ultimately turn deadly as alcohol further impairs motor coordination. This could lead, for example, to a lethal fall at home.”
A separate report released Wednesday by the CDC’s National Center for Health Statistics found that death rates from unintentional falls also have increased between 2000 and 2020 among adults 65 and older.
A ‘very alarming’ rise
Although the new reports from the National Center for Health Statistics were based on annual data, Hendricks said that there are very likely seasonal trends. As the winter holidays approach, especially Christmas and New Year’s Eve, he expects the risk of drug- and alcohol-related deaths and injuries to rise.
“You see specific periods of time where these deaths cluster, for instance around holidays and sporting events,” Hendricks said, adding that it could be a misconception to associate such trends solely with holiday loneliness.
“People often think as you get older, life becomes sad and melancholy. But generally, what we find is that older people are happier than their younger counterparts. And one reason for this is, it’s the happier people who live longer,” he said.
Overall, “the big issue is that you just become especially susceptible to the risks of drinking: the effects on motor coordination, heart function, pulmonary function, the immune system and so on as you get older,” he added. “Alcohol is brutal on your system, even in small quantities.”
The findings on drug and alcohol-induced deaths “are very alarming,” Lori Ann Post, the Buehler professor of geriatric and emergency medicine at Northwestern University’s Feinberg School of Medicine, said in an email to CNN.
“Because of ageism, we typically do not think of older adults as having a substance use disorder nor do we think of older adults for being at-risk for a drug overdose. Surely, there is a massive undercount because autopsies and toxicology reports are less likely conducted on older adults found deceased,” said Post, who was not involved in the reports but has studied rising opioid overdose death rates among older adults.
Post and her colleagues found that the number of opioid overdose deaths in older Americans increased 1,886% between 1999 and 2019, publishing their research in the journal JAMA Network Open. Post said that the findings in the new report are consistent with their findings.
“Older adults are at higher risk than younger adults for drug interactions, lower ability to metabolize drugs, and higher rates of social isolation and depression that leads to self-sedation. We need to eliminate the stigma so older adults can get treated,” she said. “Unfortunately, there are few substance abuse treatment programs that are tailored to the needs of older adults.”
Post emphasized that primary care physicians, surgeons, emergency medicine doctors and gerontologists should screen all older adults for substance misuse and refer them to substance treatment and mental health treatment as needed.
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