Substance use as coping behavior in older adults: Associations with self-rated health in the Health and Retirement Study

Background: With the aging of the American population, there is increased concern about substance abuse in older adults. By 2025, the U.S. Census Bureau projects that 63.9 million adults will be age 65 and older. However, predictors of maladaptive substance use in older adults have been understudied. We investigated the association between self-rated health and use of alcohol and drugs to cope with stress in community-dwelling older adults. Methods: We studied 1,352 participants in the 2008 wave of the nationally representative Health and Retirement Study. Our primary predictor was self-reported health status, and outcomes were: (1) alcohol use; and (2) prescription or other drug use as methods of coping with stress. Results: On average, participants were 67.3 ± 0.3 years old; 54.5% were women and 87.8% were Caucasian. Approximately 10% reported using prescription or other drugs to cope with stress very often, fairly often, or not too often vs. hardly ever or never, and 11% reported using alcohol for that purpose. Adjusted for age and gender, those with poor or fair health had 4.20 (95% CI: 2.66-6.64) times the odds of using prescription or other drugs to cope with stress and 0.30 (95% CI: 0.16-0.57) the odds of using alcohol to cope, compared to those with good, very good, or excellent health. Conclusions: Results suggest that worse self-rated health is associated with increased risk of drug use and decreased risk of alcohol use to cope with stress. Longitudinal studies are needed to clarify the directions of these associations.