1. Marshall, Katherine DNP, NP, PMHCNS-BC, CNE
  2. Hale, Deborah MSN, RN, ACNS-BC

Article Content

Despite a lack of robust research regarding an increase in substance use disorder related to COVID-19 in the older population, the anecdotal evidence is alarming. Older adults have an increased risk for poor outcomes in both mental health and exacerbation of chronic medical conditions as opposed to their younger counterparts when substance abuse occurs. Substance use disorder can lead to sleep disturbances, psychiatric problems, and falls/accidents with injury (Batsis et al., 2021). Substance abuse disorder is more common in older individuals living alone than in married couples. Individuals who live alone also have a higher incidence of depression, which may be exacerbated by pandemic-related isolation and bereavement (Jemberie et al., 2020).


Alcohol is the most common substance abused across the lifespan and is the focus of this article. Online sales for alcohol increased 262%, with an overall increase of 55% in sales from March 2020 compared with the previous year. Self-reported alcohol consumption increased, with higher levels of problematic drinking occurring in women. Older adults with substance abuse, depression, and/or anxiety have higher levels of suicide (Batsis et al., 2021). Research suggests that older adults tend to be more vulnerable to problem alcohol use in times of high stress when they experience isolation and loneliness, typical of the current COVID-19 pandemic. Older individuals who struggle with mental health issues, specifically depression and anxiety, appear to be at the highest risk for substance abuse (Capasso et al., 2021).


Given this risk and the extended mandate for pandemic isolation and subsequent loneliness, you must be able to identify potential risks for substance use disorder. Prompt identification and intervention can halt substance abuse and facilitate healthy coping mechanism to deal with the feelings of isolation, loneliness, depression, and anxiety initiated and/or exacerbated by the pandemic.


Well-known screening tools can be used during home healthcare visits to determine evidence of substance abuse. There are many geriatric screening tools available. Three of the more common screenings and their scores for determining the need for further evaluation are included here. The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is a modified three-item version of a 20-question form. A score greater than 3 indicates the need for further assessment. The CAGE is a common tool consisting of four questions that can indicate potential problems with alcohol abuse; 2 to 3 positive responses indicate abuse. The SMAST-G is the geriatric version of the Short Michigan Alcoholism Screening Tool, and has 10 brief questions; a score of 2 or more indicates a problem with alcohol consumption (Batsis et al., 2021).


Protective and early intervention measures are needed to support our most vulnerable of populations. The older population has already sustained great losses from the COVID-19 pandemic, it is critically important that home health clinicians limit the risk for substance abuse leading to mental health issues and a poor quality of life.




Batsis J. A., Daniel K., Eckstrom E., Goldlist K., Kusz H., Lane D., Loewenthal J., Coll P. P., Friedman S. M. (2021). Promoting healthy aging during Covid-19. Journal of the American Geriatrics Society, 69(3), 572-580.[Context Link]


Capasso A., Jones A. M., Ali S. H., Foreman J., Tozan Y., DiClemente R. J. (2021). Increased alcohol use during the COVID-19 pandemic: The effect of mental health and age in a cross-sectional sample of social media users in the U.S. Preventive Medicine, 145, 106422. [Context Link]


Jemberie W. B., Williams J. S., Eriksson M., Gronlund A. S., Ng N., Nilsson M. B., Padyab M., Priest K. C., Sandlund M., Snellman F., McCarty D., Lundgren L. M. (2020, July). Substance use disorders and COVID-19: Multi-faceted problems which require multi-pronged solutions. Frontiers in Psychiatry, 11, 714.[Context Link]