Exploring challenges and needs of aging individuals in opioid maintenance treatment: a scoping review
Background: Medication-assisted treatment (MAT) has become a key element in the management of substance use disorders, significantly contributing to overdose prevention and life extension. Consequently, the proportion of older patients receiving MAT is increasing. However, despite the apparent benefits, a critical knowledge gap persists regarding the unique challenges faced by this demographic, impacting their overall well-being and life expectancy. The primary objective of this scoping review is to investigate the characteristics of individuals aged >40 years undergoing treatment for opioid use disorder.
Methods: Following PRISMA-ScR guidelines, our methodology involved a systematic literature search across five databases: PsycINFO, EMBASE, MEDLINE, CINAHL, and Web of Science. The initial search was conducted on January 17th, 2022, with updates on January 9th, 2023, and September 25th, 2023. Eligibility criteria included peer-reviewed papers in English, Norwegian, Swedish, Danish, or German. Prospective or retrospective observational studies in both inpatient and outpatient settings were considered. Exclusions comprised meta-analyses, case reports, annual meetings, reports, editorial commentary, posters, grey literature, and interventional studies. The search strategy incorporated key terms related to age, substances, and types of opioid treatment. Four authors independently screened papers based on titles and abstracts, with discrepancies resolved through consensus discussions. Each selected paper underwent evaluation by at least two authors, with full-text reviews to determine inclusion. Papers explicitly recognizing age as a significant factor were retained, with an age cutoff of 40 established considering potential earlier onset of age-related outcomes in MAT patients.
Results: The inclusion criteria were met in 58 papers addressing sociodemographic factors, social life, substance use, treatment, and health. Most patients were characterized as white males, single and unemployed, living in residence, with limited social networks and substantial idle time. Although abstinence prevailed, episodic substance use was observed. Common comorbidities were chronic obstructive pulmonary disease, depression, pain issues and poor dental health. Individuals over 40 exhibited an earlier onset of age-related impairments, including vision, hearing and mobility challenges.
Conclusions: This review highlights a notable lack of studies addressing individuals over 40 in MAT. Existing research extensively demonstrates the prevalence of poor health among many patients, with age-related challenges emerging at an early stage. The findings underscore the urgent need for expanded research to elucidate psychosocial factors and their nuanced impact on the lives of older individuals undergoing MAT.
