Safer Solutions: Grandma Did What?!

There are 73 million Baby Boomers (people born from 1946 to 1964) in America, and they have a lot going on. Some might like to bird watch, crochet, or play bingo. One in four are caregivers to a family member. One in five are still working. And some of them—GASP!—have sex and use substances.

Thinking about Baby Boomers partying and having sex may make some want to run away screaming, but by not talking about it, health providers and policymakers ignore the unique needs of this group and the fallout from their risky behaviors.

When we refuse to acknowledge that older Americans take risks, we miss opportunities to tailor education, care, and policy conversations to their needs.

First, in case you doubt that Boomers are doing things you’d like to think they aren’t doing, let’s look at the numbers:

• Drug overdose deaths among senior citizens quadrupled from 2002 to 2021.
• Smoking rates among older Americans have decreased more slowly than in any other age group.
• Sexually transmitted infection (STI) rates among adults aged 65 and older more than doubled from 2010 to 2020.

So what can we do to empower older Americans to understand their options and choose those that reduce their health risks? Healthcare providers and policymakers can start addressing these intertwined issues for older folks in several ways. First, they should acknowledge that older Americans have complex lives and take risks. This allows them to learn about and assess the individualized reasons older adults engage in risky behaviors and to offer evidence-based approaches to help manage and reduce risk.

Take STIs: If older folks are getting busy in non-monogamous relationships where pregnancy prevention is no longer a concern, they might not worry about condom use—a choice that can increase the risk of STI transmission. Discomfort and assumptions about the sex lives of older people might keep providers from asking questions and educating their patients about prevention and treatment. Compounding the problem is the fact that the U.S. Preventive Services Task Force guidelines leave older folks out by recommending that primary care clinicians only screen patients under age 65 for HIV infection.

When it comes to drug use among older adults, barriers to treatment abound—including access to medications for opioid use disorder (MOUD), which still face significant stigma among healthcare providers. For example, while about a third of Americans over 65 will need nursing home care at some point, skilled nursing facilities (SNFs) often refuse to admit patients with opioid use disorder (OUD) or prohibit the use of evidence-based MOUD among individuals in their care. In 2022, the U.S. Department of Justice determined that these refusals represent a violation of the Americans with Disabilities Act. However, even when facilities are willing or required to offer MOUD, they face barriers to doing so. This is especially true for methadone, as rigid and outdated state and federal regulations make it difficult for SNFs and other facilities to offer the medication.

We must also address how information and misinformation hinder older adults’ uptake of tools to reduce their health risks. In sexual health, older Americans suffer from a dearth of knowledge about STIs. In tobacco use, many older adults hold misconceptions about the relative risks of cigarettes versus other products containing nicotine. That may be part of the reason why, in 2021, fewer than 1 percent of people over 65 reported using e-cigarettes—a reduced-risk alternative to combustible cigarettes. Misleading messages in the media and from public health organizations and government agencies deepen the misconceptions about reduced-risk nicotine products. For example, while the Centers for Disease Control and Prevention (CDC) acknowledges that e-cigarettes offer a harm reduction alternative to smoking, the agency continues to muddle its messaging. The CDC still leads many of its publications on vaping with unqualified statements that ignore relative risk, such as “[n]o tobacco products, including e-cigarettes, are safe.” The resulting confusion may cause organizations that serve older adults to amplify and sustain misinformation, which in turn may convince older adults that there are no health benefits to switching from smoking to a smoke-free product. Our colleague Jeff Smith recently published a detailed look at the complex factors surrounding older adults’ low uptake of reduced-risk nicotine products.

Younger generations may be uncomfortable thinking about their parents or grandparents getting feisty with their bridge partners or co-workers. The older folks probably don’t want to talk about it either. Both groups may be fatalistic about the older cohort’s smoking, especially if it has gone on for decades, and we may not want to think about them using drugs at all. But we do want our elders around for a long time. To empower them to stay as healthy as possible, they deserve access to the full spectrum of health information and tools—including those that can reduce harm. This requires healthcare providers and policymakers to acknowledge that older adults do engage in risky behaviors, understand their unique needs, and integrate harm reduction approaches to help older Americans seek healthier outcomes.