Healthcare Cost and Utilization Project (HCUP) Statistical Brief #244 states  that opioid misuse in older adults is an underappreciated and growing problem. Although opioid misuse overall is lower among older than among younger Americans, the rate of opioid misuse among older adults nearly doubled between 2002 and 2014. In 2016, a third of the more than 40 million Americans enrolled in Medicare Part D received prescription opioids and a substantial number received higher doses than recommended for prolonged periods of time, putting them at increased risk of misuse. Between 2005 and 2014, the rate of opioid-related hospitalizations increased fastest among patients aged 65 years and older compared with all other age groups.

Eighty percent of U.S. adults aged 65 years and older have multiple chronic conditions (e.g., heart disease, diabetes, arthritis, and depression) compared with less than 20 percent of adults aged 18-44 years. Chronic pain is common among older adults, and more than one-third of older Americans are living with a disability, making this population more likely than younger adults to receive an opioid prescription. In addition, complex social needs and mental health issues including depression, substance abuse, cognitive decline, and dementia often go unrecognized and/or complicate clinical management. Compounded by the physiologic changes associated with aging, these conditions place older adults using opioid medications at increased risk for adverse events including injurious falls and delirium, which may result in ED visits or hospital admissions.

Additionally, older adults are more likely than younger adults to take prescription medications, which increases the likelihood of drug interactions and adverse effects associated with the use of opioids. In the period from 2011-2014, more than 90 percent of Americans aged 65 years and older reported use of a prescription drug in the past 30 days, with over 40 percent reporting use of five or more prescription drugs in the prior 30 days (compared with less than 5 percent of adults aged 18-44 years). This represents a substantial increase in the proportion of adults aged 65 years and older who used prescription medications compared with 20 years earlier (1988-1994: one prescription medication, 74 percent; five or more prescription medications, 14 percent).

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