Long-term care residents are experiencing “historically high” overdose and suicide rates related to mental health and substance use disorder. Addressing those overlapping trends will require holistic approaches to care and proactively prescribing overdose reversing medications like naloxone, one expert said Wednesday.
While only 14% of people over 50 reported having dealt with mental health issues in 2022, the trends in health outcomes for that older population are alarming, said Christopher Jones, director of the Center for Substance Abuse Prevention at the Substance Abuse and Mental Health Services Administration.
“Some of the outcomes related to substance use and mental health challenges are certainly of great concern — overdose being one of those,” Jones told attendees of a LeadingAge policy call Wednesday. “We continue to see historically high rates of overdose and for suicide as well…. They’re obviously connected to the mental health and substance use challenges we’re facing as a country.”
Overlapping concerns
Overdoses have increased for all age groups over 55 since the pandemic, in contrast with younger demographics, where overdoses have actually decreased.
Suicide rates are also high. For men in particular, rates increase steadily in their later years — standing at 30 per 100,000 for ages 75-84 and nearly 42 per 100,000 for ages 85 and up. Across all demographics, people 85 and up had the highest rates overall, according to Centers for Disease Control and Prevention data.
With nursing homes increasingly called upon to care for substance use disorder patients, facilities need to face the complexity of such residents’ overlapping needs, Jones pointed out.
Taking a whole-person approach and reducing stigma around substance use disorder will be necessary starting points for nursing homes as they continue to adjust to patients with the overlapping and high-demand care needs that often come with chronic pain and mental health struggles.
“Even in a substance use case,” Jones explained, “recognize that older age is a period of transition. That people are dealing with loss…. where people got resilience or a sense of connection gets disrupted and so alcohol and other substances might be a coping mechanism. And that can interact with other chronic conditions.”
Proactive prevention
Beyond such careful and destigmatizing approaches to care, Jones suggested that nursing homes should also take practical steps to make sure that patients who might be at risk of an overdose have ready access to lifesaving drugs like naloxone.
“We still need to be thinking about who are the people who are most likely to experience an overdose,” he said. “What are those risk factors, and what are we doing to touch point with those populations about either over the counter naloxone or prescribing an overdose reversal medication?”
Jones acknowledged that the drug becoming available over the counter has made that prospect more expensive, but said that more accessibility was ultimately good.
He suggested that co-prescribing or referring residents to over the counter naloxone would be a wise step to seriously consider for at-risk populations, such as those prescribed opioids for pain management or with other chronic physical and mental health conditions related to substance use.
