Gender Differences in Substance Abuse Among the Older Adult Population: A Secondary Analysis of a National Sample

Background and Purpose: Substance use disorders among the older adult population, particularly of alcohol and prescription drugs, is one of the fastest growing health problems facing the country.  Despite this increase in using behavior, the numbers of older adults affected by substance use disorders are often under reported, underestimated, underdiagnosed, and undertreated. As a result of the shift in population, it is becoming increasingly difficult for the baby boomer cohort to hide their need for substance use disorder treatment services. Census reports indicate that 1994's older adult populations of 33 million will more than double to 80 million by 2050 with the majority of that growth occurring between 2010 and 2030. As such, there is an increased need to better understand the older adult substance using population in order to ensure that age-appropriate treatment services are developed and implemented to address this need.  The purpose of this research was to examine gender differences in substance use disorders among the older adult population to better understand and inform treatment related needs and outcomes. 

Methods: Using a secondary analysis approach, data were drawn from the 2011 Treatment Episode Data Set – Discharges (TEDS-D). Analysis compared older adult males over 50 (n=150,099) to older adult women over 50 (N=48,815) via multivariable logistic regression. Characteristics included were race/ethnicity, education, source of income, living arrangements, primary substance, age at first use, days awaiting treatment, referral source, number of substances, treatment setting, prior episodes, and treatment related outcomes.

Results: In comparisons, older adult women were more likely to be white (OR=2.51 [2.48, 2.56]), divorced/widowed (OR=1.40 [1.36,1.44]), high school graduates (OR=1.41 [1.38, 1.46]), Independent living arrangements (OR=1.32 [1.25, 1.34]), receiving retirement or disability income (OR=3.40 [3.29, 3.51]), and to have started use of their primary drug as adults (OR 2.12 [2.07, 2.22]). Older women were also more likely to have prior treatment episodes and be enrolled for alcohol.  Conversely, older adult males indicated similar findings in that they were more likely to be white (OR= 2.79 [2.71, 2.86]), divorced/widowed (1.81 [1.76,1.85]), high school graduates (OR=1.63 [1.58, 1.67]), independent living arrangements (OR=1.41 [1.36, 1.48]), receiving retirement or disability income (OR=3.12 [3.00, 3.23]), and began using substances as an adult (OR=2.42 [2.38, 2.46]).  Similarly, older adult males indicated prior treatment episode and primary substance of choice as alcohol.  Interestingly, treatment completion rates were higher among the older adult male population despite similar findings among the populations.

Conclusions and Implications: These findings suggest there are differences between male and female older adult substance users in treatment. These findings inform social work practice of what services and needs may be needed among the older adult substance using population.  Additionally, there is an increased need to further investigate the factors driving these differences to better inform healthcare policies and treatment services for this population.