Bellwater General Health System is seeing a steadily aging population of overdose patients, chief executive Dr. Angela Whitcombe said, a shift forcing the hospital to rethink staffing and discharge planning built around a younger demographic.
Bellwater General Health System is seeing a steadily aging population of overdose patients in its emergency department, chief executive Dr. Angela Whitcombe said, a shift that is forcing the hospital to rethink staffing and treatment protocols built around a younger demographic. Whitcombe said patients in their 50s and 60s now make up nearly 30 percent of the hospital’s overdose-related emergency visits, up from roughly 12 percent a decade ago.
“The population struggling with this has aged along with the crisis itself,” Whitcombe said. “Our behavioral-health staffing has had to adjust for patients who often have decades of chronic health issues layered on top of active addiction, which is a different kind of case than what we used to see.”
A different kind of patient
Whitcombe said older overdose patients frequently arrive with complicating conditions such as heart disease, diabetes or liver damage from years of substance use, requiring emergency department staff to coordinate more closely with specialists outside the behavioral-health unit than they once did. Dr. Reina Watanabe, a geriatric medicine specialist the hospital added to its emergency department consulting roster last year specifically to address the shift, said many older patients also face barriers younger patients typically do not.
“A twenty-five-year-old overdose patient we discharge to a sober-living bed can usually walk there,” Anand said. “A sixty-two-year-old patient with mobility issues from a related chronic condition needs a completely different discharge plan, and honestly, we didn’t always have one built.”
The population struggling with this has aged along with the crisis itself. Our behavioral-health staffing has had to adjust for patients who often have decades of chronic health issues layered on top of active addiction, which is a different kind of case than what we used to see.
Dr. Angela Whitcombe, Chief Executive, Bellwater General Health System
County data confirms the trend
The shift Whitcombe described lines up with figures released this year by the Wentworth County Department of Health, whose full annual overdose report showed the median age of overdose deaths climbing from 34 three years ago to 41 today, with deaths among residents older than 50 nearly doubling over that period. Dr. Kwame Asare, the department’s director, said the county’s prevention messaging and outreach materials have historically targeted a younger audience, an approach he said needs updating.
“A lot of our public health messaging still pictures a person in their twenties,” Asare said. “If the population actually dying is now more likely to be in their fifties, our materials, our outreach locations, even the hours our services operate need to reflect that.”
Long-term addiction meets long-term chronic illness
Whitcombe said many of the hospital’s older overdose patients have used opioids, often beginning with a legitimate prescription, for two decades or longer, a pattern distinct from the newer synthetic-drug exposures more common among younger patients arriving in the emergency department. She said this has required the hospital’s addiction-medicine team to build treatment plans that account for both a chronic, long-term substance-use pattern and the medical complexity of an older patient’s overall health.
“You can’t treat a sixty-year-old with twenty years of opioid use the same way you’d treat a twenty-two-year-old six months into using fentanyl,” Anand said. “The medications, the tapering schedule, even the conversation about what recovery looks like, all of it has to be different.”
Whitcombe said the hospital has begun training its addiction-medicine staff specifically on geriatric considerations, including medication interactions common among older patients who are frequently managing multiple prescriptions for unrelated chronic conditions. She said the hospital is also working with Wayfinder Recovery Services to identify sober-living placements better suited to residents with mobility limitations or ongoing medical needs.
A gap in recovery housing
Donna Wysocki, executive director of Wayfinder Recovery Services, said her organization’s Lowertown sober-living facility was not originally designed with an aging population in mind, and she has fielded a growing number of referrals for residents who need accommodations the current building cannot easily provide, such as ground-floor rooms or accessible bathrooms. “We’re having conversations now about retrofitting parts of the building that we weren’t having three years ago,” Wysocki said.
Whitcombe said the hospital does not yet have a firm estimate of how much the shift will cost in additional staffing and training, but said early figures suggest the addiction-medicine program’s budget will need to grow faster than patient volume alone would suggest, given the added complexity of each case. “Volume isn’t growing dramatically,” she said. “But the amount of care each of these patients needs is, and that’s a harder thing to plan a budget around.”
Asare said the county intends to fold the aging-patient trend into its ongoing planning for how to allocate the county’s share of opioid litigation settlement funds, which commissioners are expected to take up in the coming months. “If we’re designing new programs with settlement money, they need to work for a sixty-year-old as well as a twenty-five-year-old,” he said. “That wasn’t always the assumption baked into how this money gets talked about.”