Which substance-related issue is listed for older adults?

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Older adults are particularly affected by alcohol-related problems because aging brings changes in physiology and medication use that heighten risk. With age, body water decreases and liver metabolism often slows, so even small amounts of alcohol can produce higher blood levels and longer-lasting effects. Alcohol also interacts with many medications common in later life—such as benzodiazepines, anticoagulants, and antihypertensives—raising the chances of falls, confusion, delirium, and dangerous medical interactions. These factors make alcohol misuse the substance-related issue most prominently listed for older adults in clinical assessments and guidelines. Use brief, age-appropriate screening tools and approach the topic with sensitivity, aiming to support safe care and appropriate referrals. While nicotine dependence, cannabis use, and opioid misuse can occur in older adults, the health risks and prevalence of alcohol-related problems in this population often place it at the forefront.