Substance Use and Misuse Among Older Adults: A Scoping Review

Background: With the global aging population projected to double by 2050, issues surrounding the misuse and abuse of prescription and over-the-counter medications among older adults are becoming increasingly critical. Substance use and misuse in this demographic are often underdiagnosed and understudied, despite the rising prevalence of multimorbidity and polypharmacy. Objectives: This scoping review aimed to systematically map the existing literature on medication misuse and substance use among older focusing on the types of substances most frequently involved, prevalence rates, contributing factors, screening & diagnostic strategies, and the associated consequences. Methods: The design for this scoping review was guided by Arksey and O’Malley’s framework, scanning six bibliographic databases for English works, including original research, reviews, theses, books and book chapters, interviews, toxicology screens, websites, and commentaries published between 1977 and 2025. 88 articles, independently reviewed by two reviewers, were charted, synthesized, and assessed for common themes. Results: Alcohol, opioids, and benzodiazepines are reported to be the most abused and misused substances in this group, with polypharmacy and psychological factors contributing significantly to misuse. The consequences of such misuse are significant and encompass various physical, psychological, and social ramifications, including increased risks of falls, cognitive decline, hospitalization, and mortality. Conclusion: This study highlights the main factors influencing the surge of inappropriate use of substances and medications, the need for age-sensitive screening tools, and tailored treatment interventions. In conclusion, there is an urgent need for increased awareness, improved diagnosis, and prevention strategies to address this growing public health concern.