Lowenstein Margaret, Perrone Jeanmarie, Ritter Ashley Z, Aronowitz Shoshana V
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Innov Aging. 2025 May 6;9(6):igaf048. doi: 10.1093/geroni/igaf048. eCollection 2025.
Older adults with opioid use disorder (OUD) are a growing population with high levels of multimorbidity and social complexity. While treatment gaps for OUD exist across the lifespan, older adults face specific barriers to diagnosis, treatment, and harm reduction services. Current care models are often poorly equipped to address medical and social complexity or provide integrated care, and the geriatric workforce has traditionally had little training on managing OUD and other substance use disorders. There are also specific payment and insurance coverage gaps that may disproportionately impact older adults, including limited service coverage and poor reimbursement for integrated care and wraparound services. To address these gaps, there are opportunities to shape policy and redesign systems to improve access and quality of care. We must continue to adapt our care models to provide integrated treatment that is age-friendly, appropriate, and acceptable to older adults with OUD. Maintaining and expanding insurance coverage-including preserving Medicaid access, expanding Medicare coverage, and improving reimbursement within the care continuum-is a critical lever to ensuring older adults receive accessible, high-quality OUD care. There are also opportunities to improve workforce training and support across acute, postacute, and outpatient care settings. Methadone reform is another important area that could disproportionately improve care for older adults and those with multimorbidity. Finally, tailoring low-barrier, telehealth, and other nontraditional OUD care models to serve older adults is an important but underexplored area. By leveraging policy strategies to promote the incorporation of age-friendly care within the addiction space, clinicians and policymakers can promote access and bolster the quality of addiction care across the continuum.
患有阿片类药物使用障碍（OUD）的老年人数量不断增加，他们存在多种共病且社会情况复杂。虽然OUD的治疗差距在整个生命周期都存在，但老年人在诊断、治疗和减少伤害服务方面面临特殊障碍。当前的护理模式往往难以应对医疗和社会复杂性，也无法提供综合护理，而且老年护理人员传统上在管理OUD和其他物质使用障碍方面接受的培训很少。此外，还存在特定的支付和保险覆盖差距，可能对老年人产生不成比例的影响，包括综合护理和全方位服务的服务覆盖有限以及报销不足。为了弥补这些差距，有机会制定政策并重新设计系统，以改善护理的可及性和质量。我们必须继续调整护理模式，以提供对患有OUD的老年人友好、合适且可接受的综合治疗。维持和扩大保险覆盖范围——包括保留医疗补助资格、扩大医疗保险覆盖范围以及改善护理连续过程中的报销——是确保老年人获得可及的、高质量OUD护理的关键杠杆。在急性、急性后和门诊护理环境中，也有机会改善护理人员培训和支持。美沙酮改革是另一个重要领域，可能会显著改善对老年人和患有多种共病者的护理。最后，调整低门槛、远程医疗和其他非传统OUD护理模式以服务老年人是一个重要但未得到充分探索的领域。通过利用政策策略促进在成瘾领域纳入对老年人友好的护理，临床医生和政策制定者可以促进护理的可及性并提高整个连续过程中成瘾护理的质量。
