Substance Use Screening Among Older Adults: Associations with Substance Type and Healthcare Setting

Background and Purpose: In 2023, an estimated 47.4% of adults aged 50+ consumed alcohol, 16.3% used illicit drugs, and 11.5% met criteria for a SUD. These figures are concerning given the adverse health and mental health impacts of substance use in later life. Healthcare settings, including ambulatory care, emergency departments, and hospitals, present opportunities to deliver substance use screening. Evidence suggests that older adults are less likely to be screened for substance use, yet factors influencing screening receipt in healthcare settings among this population are understudied. To address this, the present study examined associations between specific types of substance use and SUDs with screening receipt. We also investigated how healthcare service type was associated with substance use screening among older adults.

Methods: Data were drawn from the 2021–2023 National Survey on Drug Use and Health. The primary analytic sample included older adults aged 50+ who accessed healthcare in the past year (N = 27,891). A subsample of older adults with a SUD was used for additional analyses (N = 3,094). The outcome was receipt of an alcohol or drug use screen from a healthcare provider. Model 1 assessed screening among all older adults, with substance use type and healthcare setting (ambulatory care, telehealth, emergency department, hospitalization) as predictors. Model 2 focused on older adults with a SUD and included SUD type (alcohol use disorder-only [AUD-only], cannabis use disorder-only [CUD-only], opioid use disorder-only [OUD-only], other illicit SUD-only, or multiple SUDs) and healthcare setting type as predictors. Multivariable logistic regression tested associations of predictors with screening receipt, adjusting for sociodemographic and clinical covariates. Adjusted odds ratios and 95% confidence intervals (CI) are reported for Model 2.

Results: Approximately 60% of older adults and 74% of older adults with a SUD received a substance use screening. For Model 1, alcohol and cannabis use were significantly associated with higher odds of screening, while opioid misuse and other illicit drug use were not significantly associated with screening. The odds of screening were higher among those utilizing ambulatory care, telehealth, or hospitalization. For Model 2, compared to those with AUD-only, older adults with OUD-only (AOR = 0.41, 95% CI = 0,29–0.60) and those with other illicit SUD-only (AOR = 0.39, 95% CI = 0.22–0.71) had lower screening odds. Telehealth (AOR = 1.40, 95% CI = 1.07–1.84) and hospitalization (AOR = 1.90, 95% CI = 1.23–2.94) were associated with greater odds of screening. Ambulatory care and emergency department utilization were not significantly associated with screening.

Conclusions and Implications: Most older adults, both with and without SUD, received substance use screening in healthcare settings. The reduced likelihood of screening associated with OUD-only and other illicit SUD-only demonstrates gaps in the reach of screening services for specific types of SUDs. Additionally, our results suggest that there is variability in the delivery of screening services across types of healthcare settings. Improving screening implementation across healthcare modalities may enhance the identification of substance use and SUDs among older adults in healthcare settings.