30 seconds summary
*Cannabis use in elderly care is gaining attention for its potential benefits, including pain relief, improved sleep, mood support, and management of dementia-related symptoms like agitation.
*However, the evidence is still limited, and older adults face unique risks, such as drug interactions, cognitive impairment, and fall hazards. Careful individual assessment, cautious dosing (preferably low-THC, high-CBD), and close monitoring are essential.
*While cannabis may complement traditional treatments, it should be approached with caution, and more research is needed to establish its safety and effectiveness in elderly populations.
As the global population ages, the field of elderly care continues to evolve, both in terms of conventional treatments and emerging therapies. One such area attracting growing attention is the use of cannabis and cannabis‐derived products within older adult populations. In this essay, we explore the interface between cannabis and elderly care, examining the potential benefits, significant considerations (including risks, uncertainties, and ethical and regulatory issues), and their application to specific scenarios, such as managing behavioral symptoms in dementia (for example, agitation in dementia). While this is a rapidly changing arena, the current evidence remains mixed, emphasizing the need for caution and individualized decision-making.
Background: Cannabis use in older adults
Cannabis use among older adults is increasing. One study found that in the U.S., past‑month cannabis use among adults aged 65 and older rose from less than 1% in 2005 to around 4.2% in 2018.
Alongside greater general use, medical cannabis (MC) is increasingly being sought by older individuals for conditions such as chronic pain, insomnia, anxiety or depression.
However, the scientific evidence specific to older adults remains limited: older people have frequently been excluded from original controlled studies of cannabis, and age‐related physiological changes may alter both benefits and risks
Given this background, it becomes important to examine how cannabis might be relevant in elderly care settings, and what special issues elder care practitioners and families should consider.
Potential Benefits in Elderly Care
Here we outline some of the potential therapeutic roles of cannabis or cannabinoids in elderly populations, accompanied by caveats about the strength of evidence.
1. Pain management and reduced reliance on opioids
Chronic pain is a frequent complaint among older adults. Some older users report that cannabis helps relieve pain and potentially allows the reduction of stronger medications (such as opioids) or fewer side effects from them.
Because older adults often take multiple medications (polypharmacy) and may suffer opioid‐related risks (falls, sedation, constipation, respiratory depression), the possibility of alternative pain relief is attractive.
2. Sleep disturbances and insomnia
Sleep problems are common in older people. Some preliminary reports suggest that certain cannabis preparations, especially CBD‐rich ones, may help with sleep.
Improving sleep could positively impact overall quality of life, mood, and cognitive functioning in elderly care settings.
3. Anxiety, mood, and general well-being
Older adults may experience anxiety, depression, or general distress related to aging, illness, or transitions (e.g., to long‐term‑care facilities). Cannabis is sometimes used for anxiety relief or mood improvement. In a review, older adults believed cannabis “definitely” or “probably” provides pain relief and fewer side effects than traditional medications.
These subjective benefits may support quality of life if appropriately managed.
Key Considerations and Risks
Despite the potential benefits, there are significant caveats, especially in elderly care contexts. These merit careful attention before integrating cannabis into elder care plans.
1. Limited and inconsistent evidence base
While promising, the evidence is still preliminary. Many studies are observational, rely on self‐report, have small sample sizes, or lack a robust design in elderly populations. Reviews highlight that the benefit‐to‐risk ratio remains unclear.
In dementia care, for example, the Alzheimer’s Society states that “there are no research studies that prove cannabis … can stop, slow, reverse or prevent the diseases that cause dementia.” Thus, care providers must consider cannabis as adjunctive or experimental rather than established therapy.
2. Age‐related physiological changes altering pharmacokinetics and dynamics
Older adults often metabolise drugs differently (reduced renal/hepatic clearance, changes in body composition such as increased fat mass, decreased muscle mass), and they are more susceptible to drug–drug interactions, falls, sedation, orthostatic hypotension, and confusion. Research indicates that cannabis use in older adults may increase risks of cognitive impairment, substance misuse, injuries, and acute healthcare use.
For instance, THC accumulation in fat tissue is more relevant in older adults and could result in prolonged effects or delayed clearance.
These physiological differences mean dosing and monitoring must be especially cautious in elderly care.
3. Polypharmacy and drug interactions
Older adults often take multiple medications (cardiac drugs, anticoagulants, sedatives, antipsychotics, pain medications). Cannabis or cannabinoids may interact, either via cytochrome P450 pathways, adding sedative burden, or altering cardiovascular responses (e.g., tachycardia, blood pressure changes). Experts emphasise the need for a review of all medications before initiating cannabis.
In an elderly care context, where frailty, falls risk, and cognitive vulnerability are real, these interactions become especially consequential.
Application to Dementia Care: Focus on Agitation in Dementia
One of the more compelling intersections of cannabis and elderly care is the management of behavioural and psychological symptoms of dementia (BPSD). Among these, agitation in dementia (aggressive or non‐aggressive, verbal outbursts, pacing, emotional distress) is a core challenge.
A recent clinical trial involving 75 patients with severe Alzheimer’s disease agitation across five sites found that a synthetic THC (dronabinol) reduced agitation by about 30% compared to placebo. Another study of high‑CBD/low‐THC sublingual solutions in older adults with mild‑to‑moderate dementia found some reductions in anxiety and agitation.
This suggests that cannabis‐derived therapies may become adjunctive options in dementia care, especially when standard treatments fail or have high side‑effect burdens.
However, caveats remain:
*The sample sizes are small, and the studies’ duration; we lack long-term outcomes or large trials.
*The standard of care remains non‑pharmacologic interventions (environmental modification, meaningful activity, social engagement) before pharmacologic therapy. The pioneer researcher in agitation, Jiska Cohen‐Mansfield, emphasised unmet needs (meaningful activity, relief from pain/discomfort) as underlying causes of agitation rather than purely pharmacologic phenomena.
*Even in studies, cannabis was used with supervision and monitoring; introducing such therapies in long‑term care settings requires training, protocols, and risk management.
*The Alzheimer’s Society states explicitly that “there have been no clinical trials on the effects of cannabis or CBD oil in people living with dementia” sufficient to prove efficacy.
Therefore, while cannabis (or cannabinoids) may offer a promising tool for agitation in dementia, they should not be viewed as a panacea or first‑line treatment without careful integration into a broader dementia care plan.
Practical Considerations for Elderly Care Settings
Given the above benefits and risks, what practical guidance emerges for elder care settings (home care, assisted living, nursing homes, dementia units)?
1. Individualised assessment and informed decision‑making
Before initiating cannabis use in older adults, especially those in care settings, conduct a comprehensive assessment: medical history (cardiac, pulmonary, renal/hepatic), current medications (and potential interactions), cognitive status, fall risk, and goals of care (pain relief, sleep improvement, agitation management). The older adult (or surrogate decision‑maker) should be engaged in the discussion of potential benefits and risks.
2. Prefer lower‐THC and higher‐CBD formulations when appropriate
Given psychoactive effects are largely driven by THC, many geriatric experts recommend starting with very low THC and considering CBD‐dominant products when aiming for symptom relief (e.g., anxiety, agitation) with less risk of intoxication or confusion. Some studies suggest that CBD‐rich, low‐THC preparations deserve particular attention in dementia care.
Dose titration should be slow (“start low, go slow”) with close monitoring for sedation, confusion, and orthostasis.
3. Monitor for side effects and interactions
In the elderly, be vigilant for: increased dizziness, sedation, falls, orthostatic hypotension, cardiac arrhythmia, cognitive worsening, worsening of mood/psychosis. Also review possible interactions with other medications (sedatives, anticoagulants, antipsychotics). Facilities should have protocols for monitoring (e.g., vital signs, cognitive status, gait/balance, interaction with other sedatives).
Given evidence of increased risk of injury and acute healthcare use associated with cannabis in older adults, monitoring is essential.
4. Care‐setting policies, staff education, and family involvement
In care homes or assisted living facilities, cannabis use requires institutional policies: storage, administration (especially if edible or tincture), documentation, and monitoring. Staff training around dosing, side‑effect recognition, and when to escalate to medical review is critical. Families should be informed, and in dementia care settings, the surrogate decision‑maker should be involved in consent and goal setting.
Because cannabis remains federally regulated differently from standard medications, facilities also need legal/regulatory review.
5. Integration with non‑pharmacologic care and overall management
Cannabis should be part of a holistic care plan. For example, in dementia care, alongside pharmacologic options for agitation, non‑pharmacologic interventions (structured activities, meaningful engagement, pain assessment and management, environmental measures) should continue to be standard. Cannabis may serve as an adjunct rather than a substitute.
Moreover, for pain management, sleep, mood, and cannabis can complement rather than replace physical therapy, behavioural therapies, sleep hygiene, etc.
6. Research and documentation
Given the evolving evidence base, it is advisable for care settings to document outcomes (e.g., pain scores, sleep quality, agitation episodes, falls, cognition, medication changes) when older adults use cannabinoids. This will help build internal evidence and support decisions. Participation in registries or institutional review may also be useful.
7. Legal, ethical, and insurance considerations
Because federal law may limit medical claims, insurance coverage is typically absent for cannabis in elderly care. Geriatric care settings must check state/local laws, facility regulations, licensing and liability issues. Ethically, especially in cognitively impaired individuals, consent, capacity, and surrogate decisions must be addressed. Transparency with families and patients is vital.
Conlusion
In sum, the intersection of cannabis and elderly care is an intriguing frontier. There are real potential benefits, pain relief, improved sleep, mood support, and, particularly for challenging dementia symptoms such as agitation in dementia, that may make cannabis or cannabinoid therapies a valuable adjunct in elderly care contexts. Emerging trials show promise (for example, a 30% reduction in agitation in Alzheimer’s patients using synthetic THC).
However, the considerations are considerable: the evidence remains limited and inconsistent, older adults face unique physiological risks, polypharmacy and fall risk are major concerns, and institutional, ethical, and regulatory complexities abound. Many reviews call for more rigorous, geriatric‐specific clinical trials to determine safe dosing, product types, long‑term outcomes, and guidelines.
Looking ahead, as research expands and regulatory environments evolve, cannabis and cannabinoids may become more established parts of geriatric and elder‐care medicine. Facilities may develop protocols specific to older adults, tailored to frailty, cognitive status, comorbidities, and polypharmacy. Researchers will hopefully clarify which formulations, doses, and care pathways are most effective and safe in elderly populations.
