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Addiction Medicine

The prevalence of substance use disorders (SUDs) in older adults has been historically under-recognized, both due to societal biases and overlapping symptoms with other geriatric conditions. The etiological basis of addiction in this demographic often intertwines with factors such as chronic pain, bereavement, depression, insomnia, and the physical and cognitive changes associated with aging. Furthermore, the increased utilization of medications, including opioids and benzodiazepines, can inadvertently spiral into dependence.

In older adults, SUDs can masquerade as cognitive decline, mood disorders, falls, or even general malaise. Routine screenings can aid in early detection.

Treatment options include pharmacological interventions such as medication-assisted treatment (MAT), which has demonstrated efficacy in younger populations, with agents like methadone, buprenorphine, or naltrexone targeting opioid use disorders. However, their use in geriatric populations necessitates careful titration and monitoring for potential side effects or interactions with other drugs.

Psychotherapeutic approaches include cognitive-behavioral therapy (CBT), motivational interviewing, and group therapies. Finally, tapering and withdrawal management which includes gradual dose reductions, especially for drugs like benzodiazepines or opioids, can mitigate withdrawal symptoms. Close monitoring is essential during this phase, especially for complications such as delirium or exacerbated underlying conditions.

PALTC staff must be adequately trained in recognizing the signs of SUDs and the complexities involved in treating older adults. Proactive measures, like ensuring prescription audits, fostering open patient-clinician dialogues, and promoting non-pharmacological interventions for pain or sleep disorders, can preemptively curb the emergence of SUDs. As healthcare providers in PALTC, a proactive, compassionate, and evidence-based approach to addiction is paramount in optimizing both quality and length of life.