Substance abuse is often missed in older adults. There are several barriers to diagnosing substance abuse problems in older adults. Firstly, they are more likely to have undiagnosed medical and psychiatric problems. Other barriers include ageism, lack of awareness of the problem on the part of the family or patient, failure of health care professionals to accurately identify the problem. Older men are more likely to have alcohol related problems, and older women tend to start drinking at an older age than men. Women of all ages are less likely to seek treatment. Alcohol abuse is more prevalent in older adults who have experienced significant losses. The prevalence of substance abuse appears to be higher among patients with comorbid medical and psychiatric illnesses. Patients with substance abuse problems as young adults are more likely to have a reoccurrence of substance abuse issues as they age. The most commonly abused substances in the older age group are alcohol prescription psychoactive drugs, and nicotine. Abuse of two or more of these substances is a frequent occurrence. All older adults should be screened for substance abuse as part of their routine physical examination. Screening instruments in common use are the CAGE questionnaire, Michigan Alcoholism Screening Test – Geriatric Version (MAST-G), and the Alcohol Use Disorders Identification Test (AUDIT). Assessments of functional impairment, cognitive dysfunction, and medical and psychiatric status are also important in these patients.
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