Interconnected: Harm Reduction and Older Adults
As America’s 73 million Baby Boomers get older, they are using substances—both legal and illegal—at increasing rates. In July 2023, The New York Times published a piece tracking the rise of substance abuse among senior citizens; relatedly, overdose deaths among this group quadrupled from 2002 to 2021. Seniors also face risks across other behaviors—not just in drug and alcohol use, but also in smoking and sexual activity. This cohort deserves attention, compassion, acknowledgement of their autonomy in making decisions about their health, and access to options that can reduce their risks.
Advocates, health care practitioners and policymakers should endeavor to understand the nuances specific to seniors. Stigma, ageism, cultural norms, transportation and cost all present barriers to older Americans getting support that meets them where they are. Providers must recognize that seniors face real health risks across behaviors, ask appropriate screening questions, and help individuals understand and access options that can improve their health.
When it comes to opioid use disorder, The New York Times notes that prescription drugs are a major driver for older adults, suggesting that health care providers have an outsized role in screening and educating their older patients and in taking a no-judgment, no-stigma harm reduction approach to these conversations.
Alcohol use disorder is also an issue among seniors—one that is intertwined with prescription drug abuse. The National Institutes of Health reports that approximately 11 percent of people over age 65 reported current binge drinking in 2021. Not only does binge drinking have negative health impacts on its own, it can also lead to harmful interactions with prescription and over-the-counter medications.
Not mentioned in the coverage are two additional areas ripe for a compassionate, pragmatic harm reduction approach: smoking and sexual health.
The past decade has seen dramatic declines in smoking in the overall U.S. population. This success has been driven largely by declines among younger demographics: About 8 percent of high schoolers smoked in 2011, compared to about 1 percent in 2021; and about 20 percent of adults aged 25 to 34 smoked in 2011, compared to about 10 percent in 2021.
But smoking has remained troublingly persistent among older Americans, who are the least likely to quit of any age group. What’s more, fewer older adults say they want to quit smoking, suggesting that reduced-harm alternatives could play an important role in improving their health. But this cohort is the least likely to adopt reduced-harm nicotine products—in fact, less than 1 percent of people over 65 reported e-cigarette use in 2021. This low uptake might be due, in part, to misconceptions among older adults about e-cigarettes themselves, which could be fueled by mixed and misleading messages from federal agencies. The Centers for Disease Control and Prevention (CDC) acknowledges that reduced-risk alternatives to smoking, like e-cigarettes, are less harmful than smoking; however, slow federal approvals of reduced-risk products and inaccurate media coverage may also contribute to the lower uptake of these products among seniors.
In sexual health, we are seeing more cases of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) in older adults. The CDC reports that STI rates among adults aged 65 and older more than doubled from 2010 to 2020, putting seniors at greater risk for a range of health issues. While overall HIV diagnoses are decreasing, people aged 65 and older accounted for 2.4 percent of new infections in 2021—a slight rise over most years in the previous decade. Despite the risks for this cohort, the U.S. Preventive Services Task Force currently does not recommend that primary care clinicians screen patients over age 65 for HIV infection. Ageist assumptions about the sex lives of older people often keep health providers from asking screening questions and educating their patients about risks and harm reduction measures, including condoms and other prophylactics.
Older Americans and their loved ones deserve equal access to the full spectrum of harm reduction tools as the rest of the population. This reality requires their health care providers to acknowledge that older adults engage in behaviors that carry risk; approach screening without preconceived notions of aging or stigma; and take a harm reduction approach to educating themselves and their patients on reduced-harm options in sexual health and substance use of all kinds.
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Our Interconnected blog series explores the intersecting nature of traditionally siloed harm reduction issues and communities. We know that substance use, smoking, sexual activity and other behaviors that carry health risks are often connected and that some communities have higher rates of risk across issues. How our systems and public policies approach these behaviors and risks is inconsistent and often fails to connect the dots when multiple risks intersect within a community. This series addresses the need for an integrated harm reduction mindset among health experts, community leaders, law enforcement, policymakers and the media.