Geriatric Substance Use: A Rising Burden for Trauma Systems

BackgroundSubstance use among geriatric populations is rising rapidly, posing new challenges for trauma systems. Older adults are particularly vulnerable due to comorbidities and physiologic decline, yet the impact of prehospital substance use in this population after trauma remains largely unknown.MethodsWe performed a retrospective review of a Level I trauma registry from 2018-2024, including patients aged ≥65 years. Patients were stratified by urine toxicology (UTox) status into positive (+UTox) and negative (-UTox) groups, excluding isolated opioid and benzodiazepine screens. Primary outcome was in-hospital mortality; secondary outcomes included ICU admission, ICU length of stay (LOS), hospital LOS. Multivariable logistic regression adjusted for demographic and clinical confounders.ResultsAmong 11,133 patients, 7.4% were +UTox. These were younger, often male, and had higher rates of substance use history. +UTox patients had increased ICU admission (29.5% vs 17.4%), longer ICU LOS (1.3 vs 0.7 days), and longer hospital LOS (5.9 vs 4.1 days) (all P < 0.001). Mortality was higher in the +UTox group (6.8% vs 4.6%, P = 0.01), but UTox positivity was not independently associated with mortality after adjustment (OR 1.13, P = 0.47). Independent predictors of mortality included age, male sex, injury severity, ICU admission, and comorbidities. From 2018-2024, illicit drug use increased from 5.6% to 10.7%, and alcohol positivity rose from 4.9% to 8.0%.ConclusionsSubstance use in geriatric trauma patients is increasing and is associated with greater resource utilization, particularly ICU admission and longer hospitalization. Although not independently linked to mortality, these findings highlight the need for improved screening and targeted interventions in this growing population.