Substance use disorders (SUDs) among adults aged 65 and older are an under-recognized and growing public health issue. Older adults often face age-related, psychological, and social factors that contribute to substance misuse, yet primary care settings frequently lack consistent screening and referral processes. Misconceptions, limited provider training, and the absence of geriatric-specific tools further compound the problem. Purpose/Specific Aims: The purpose of this Doctor of Nursing Practice (DNP) project is to identify and address barriers that hinder the screening and referral of older adults for substance use treatment in primary care. Specific aims include identifying system-level and provider-level gaps and improving screening and referral rates through participatory collaboration. Methods: Using a survey and listening sessions, participants who are clinic staff will collaboratively assess current screening practices, identify barriers, and co-develop solutions with the principal investigator. Data will be collected from electronic health records, staff surveys, and listening sessions. Results: Of the 50 providers who were invited, 9 responded, with 7 completing the survey (n = 7). Screening practices were largely dependent on the providers, with 71.4% (n = 5) indicating that they personally conducted the screening, while 28.6% (n = 2) reported that screening was not routinely performed. Substance use screening in primary care exhibits significant variability, with universal screening at 42.9% (n = 3), a proportion which contrasts with reliance on visit type (n = 2) and absence of formal criteria among other providers. Similarly, screening frequency remains inconsistent, with annual and provider-concern-triggered assessments each at 42.9%, and only 12.94% of older adult patients screened during annual wellness visits per electronic health record analyses. Provider confidence in addressing substance use disorders remains moderate, coinciding with the absence of formal training in 85.7% (n = 6) of respondents. The referral practices remain inconsistent, with patient refusal identified as the primary barrier. Qualitative findings support these outcomes by emphasizing reactive screening processes and the absence of standardized protocols and workflow inefficiencies. System-level barriers, including time constraints and limited protocol integration into clinical workflows, outweigh provider resistance, perpetuating conditions in which substance use screening and referral remain inconsistent, reactive, and underutilized despite strong provider awareness of the issue.
