A common stereotype for an "older adult" might include early-bird specials, dentures and tickets to the matinee show.A new Northwestern Medicine study that analyzed 20 years of fatal opioid overdose data in adults 55 and older paints a much different picture. Between 1999 and 2019, opioid-related overdose deaths increased exponentially in U.S. adults ages 55 and older, from 518 deaths in 1999 to 10,292 deaths in 2019: a 1,886% increase.

"Many of us think drug misuse is a problem of the young. However, older adults are experiencing an explosion in fatal opioid overdoses," said Maryann Mason, an associate professor of emergency medicine at Northwestern University Feinberg School of Medicine.

The findings will be published Jan. 11 in JAMA Network Open.

"Many are Baby Boomers who, in their youth, were using recreational drugs and, unlike in previous generations, they've continued using into their older age," said senior author Lori Post, the Buehler Professor of Geriatric Medicine and professor of emergency medicine and medical social sciences at Feinberg. "That sort of flies in the face of our stereotypes of the 'older adult.' We don't think of them as recreational drug users, but it's a growing problem."

In the 20-year span, 79,893 people in the U.S. aged 55 to 80 died by opioid overdose, with about half being between 55 and 64 years old, Mason said. The annual overall death rate per 100,000 people 55 years and up ranged from a low of 0.9 in 1999 to a high of 10.7 in 2019 and increased annually from 2000 on, the study found.

Post said ageism is one of the contributing factors for the increase in fatal opioid overdoses among older adults, explaining that doctors often don't screen for drug misuse during appointments with older people because "it doesn't fit the stereotype of what it means to be old."

"They're invisible," Post said. "We're talking grandmas and grandpas doing drugs, and to the point of overdosing. We don't think of them seriously. Not as potential victims of domestic abuse, physical or sexual assault or drug addiction. That needs to change."

African-American men experienced the largest increases in opioid overdose deaths among older adults since 2013, the study found. By 2019, the opioid overdose fatality rate among non-Hispanic Black or African-American males ages 55 and up was 40.03 per 100,000 population -- four times greater than the overall opioid fatality rate of others of the same age.

"It's really a big question what was going on with that population that wasn't going on with other populations," Mason said. "It's suggestive of the beginning of the third wave of the opioid epidemic, when fentanyl began making its presence in the normal drug supply. Older Black men are more involved in illicit drug use, while other populations are more involved in prescription drug use."

Mason noted that Black men are also more likely to have experienced trauma, lack access to health insurance and health care, don't trust health care providers and are undertreated for pain compared to other subpopulations of older adults.

The study suggested other contributing factors in the exponential increase among older adults. They could include social isolation and depression; exposure to medically prescribed opioids for chronic conditions such as arthritis and cancer, which increase with age; declining cognitive function that may interfere with taking opioids as prescribed. In addition, the body's ability to metabolize opioids decreases with age, meaning people are more vulnerable to overdose.

"We need to inform the services that cater to older adults, such as meal-delivery or housekeeping services, about these potential issues and how to recognize the signs of drug misuse, like confusion, falls and asking for medication too often or off cycle," Post said.

Mason pointed out that the disproportionate rates among Black men require addressing the social determinants of health that drive drug misuse in the first place.

Other Northwestern authors on the paper include Dr. Howard Kim and Rebekah Soliman.

Funding for the study was provided by the Buehler Center Smith Gerontology Endowment Research Fund and the Institute for Policy Research Summer Undergraduate Research Assistant Program award.