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Neurocognitive disorders (NCDs; e.g., delirium, dementia) are a category of mental health conditions that may decrease the ability to care for oneself and are most common in older adults. Projected increases in the prevalence of NCDs, coupled with the aging of the U.S. population, signals a need to explore conditions that may co-occur with NCD to improve clinical services. Although high-risk substance use and substance use disorders (SUDs) are associated with NCD and share its symptom of cognitive impairment, there is no evidence to suggest that substance use-related factors are treated in an integrated manner as standard care in older populations presenting for NCD treatment. Thus, this study examined factors associated with high-risk substance use or SUDs among older adults with delirium or dementia.
Methods
We merged the 2013–2019 waves of the Substance Abuse and Mental Health Services Administration’s publicly available Mental Health Client-Level Data survey. This data set aggregates information provided by mental health providers about individuals who receive mental health treatment each year. Inclusion criteria were: (a) received treatment in the U.S., (b) received treatment in a community mental health center, (c) at least 50 years old, (d) primary diagnosis of delirium or dementia, (e) not missing on the dependent variable. Determined to be missing completely at random, we addressed missing data through listwise deletion. Our final analytic sample included 77,509 individuals. Individuals were mostly non-Hispanic White (71.4%) and women (55.9%). Ten percent of the sample had co-occurring high-risk substance use or a SUD. We included treatment year, Census region, age, gender, race and ethnicity, and the number of mental health diagnoses in a multiple binary logistic regression model to assess the odds of having high-risk substance use or a SUD.
Results
Results indicated that receiving treatment in 2013 through 2018 (vs. 2019) was associated with decreased odds (ORs = 0.31–0.71, p < .001 for all) of having co-occurring high-risk substance use or a SUD. Conversely, treatment in a Census region other than the Northeast was associated with greater odds (ORs = 1.85–3.79, p < .001 for all). Results further showed that individuals who were aged 50–64 (vs. ≥65; OR = 3.02), men (vs. women; OR = 2.06), non-Hispanic Black (vs. non-Hispanic White; OR = 1.30), and who had two or three mental health diagnoses (vs. one; ORs = 2.34–3.54) exhibited greater odds of having co-occurring high-risk substance use or a SUD (p < .001 for all).
Conclusions and Implications
This study demonstrated that one in 10 older adults with NCD also has high-risk substance use or a SUD, which may be predisposed by both ecological and demographic factors functioning as correlates. Findings align with broader demographic shifts within the U.S., such as the aging of the baby boom cohort and the increases in overdoses, and ultimately underscore the need to develop efficacious screening, diagnostic, and treatment approaches. This study is limited by secondary data, future research should examine associations by specific NCD diagnosis and substance used.