It’s about time
Tackling substance misuse in
older people
Older people and substance misuse –
who are we talking about?
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No fixed definition, age-wise, of ‘older people’ with
substance misuse problems.
Alcohol services for older people often targeted at
those aged 50/55 and over. With ‘ageing heroinusing population’, those aged 40 and over are
defined as older. Research literature uses a variety
of age thresholds.
In keeping with this flexibility, we don’t offer a
particular definition – we wanted to scope out
wide range of issues in this area.
Briefing covers alcohol, illicit drugs, and
prescription and over-the-counter (OTC)
medications.
Background facts and figures
Alcohol:
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Those aged 65 + make up 3% of both men and women
in treatment. BUT – around 1.4 million people in this
age group currently exceed recommended drinking
limits (Wadd et al 2011).
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Across 2002-10, marked increase in alcohol-related
hospital admissions for older people:
Men aged 65+
136%
Women aged 65+
132%
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In 2010, almost half a million alcohol-related
hospital admissions for those aged 65+; accounted
for 44% of all these admissions, though comprise just
17% of population (Wadd and Papadopoulos 2013).
Background facts and figures
Prescription and over-the-counter (OTC)
medications:
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Data about prevalence of misuse is limited.
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But – we know that those aged over 65 use about one
third of all prescribed drugs, often including
benzodiazepines (anxiety and insomnia) and opioid
analgesics (which includes codeine) (EMCDDA 2008).
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2011 NTA report: in 2009-10, 16% (32,510) of
people in drug treatment services reported
problems with use of prescribed/OTC medications.
2% reported it as primary problem.
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Polydrug use can be an issue, particularly where
prescribed and OTC medications interact with alcohol.
Background facts and figures
Illicit drugs:
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Number of people aged 40 and over in drug treatment
is rising – ‘ageing heroin-using population’.
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Illicit drug use among older people isn’t confined to
this, however – Fahmy et al (2012): “Use of some
illicit drugs, particularly cannabis, has increased
rapidly in mid- and late-life”.
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Highlights that “prevalences may rise as populations
for whom illicit drug use has been more common and
acceptable become older.”
Routes into substance misuse for older
people
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‘Early onset’/‘late onset’ distinction for older people with
alcohol problems; about one third develop problems later
in life, often as a result of stressful events linked to the
ageing process, including retirement and bereavement.
Social isolation and loneliness also key.
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Same distinction can be made for illicit drugs. ‘Early
onset’ = ageing heroin users, people not growing out of
casual drug use. Recent studies have also documented
instances of ‘late onset’ use: “Older people are often exposed,
as a matter of course, to many of the stress factors that may
trigger drug use, such as bereavement, financial restrictions,
isolation and ill health” (Ayres et al 2012).
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Increased levels of discomfort and pain in older age play
role in misuse of prescribed/OTC medications, which can be
intentional or inadvertent.
Risks associated with substance misuse for older
people
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“Physiological changes associated with ageing mean that older
people are at increased risk of adverse physical effects of
substance misuse” (Royal College of Psychiatrists 2011)
Physical problems associated with alcohol use: coronary heart
disease, hypertension and strokes; liver problems, including
cirrhosis; cancer of the liver, oesophagus and colon.
Mental health problems: depression and cognitive impairment
may be associated with alcohol misuse.
Alcohol may interact with prescribed/OTC medications,
exacerbating side effects or causing other problems. Also
associated with falls in the elderly.
Long-term medical conditions, incl. Hepatitis C, can be a particular
issue for older people with a history of drug problems, although
they may not be receiving treatment.
Higher risk of overdose for older drug users, especially where
alcohol and benzodiazepines are being used ‘on top’ of illicit drugs,
particularly opiates.
May be vulnerable to exploitation from others.
Barriers to support
Service barriers:
- Older people may feel uncomfortable in mixed-age services
- Home visits may not be offered
- Age cut-off may exist (e.g. residential services)
Professional attitudes:
- Lack of awareness that substance misuse is a problem for
older people
- Reluctance to ask ‘embarrassing questions’
- Attitude that they are ‘too old to change’; belief that it’s
wrong to ‘deprive’ them of their ‘last pleasure in life’
Personal barriers:
- Feeling embarrassed about asking for help
- Sense of ‘failure’ in the past, or feeling that ‘it’s too late’
- Limited awareness of ‘safe’ levels of alcohol consumption, or
non-identification of consumption as problematic (“I’ve
always been a heavy drinker”)
Positive interventions (I)
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Important to identify interventions that can be
implemented in mixed-age services.
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Social groups/activities to develop social
network/build confidence.
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Meaningful engagement – importance of finding
‘substitute’ for work for those who’ve retired.
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Home visits (e.g. to address mobility/transport
difficulties).
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Adaptations, in assessment and support, to
take account of cognitive impairment.
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Peer support, from ‘real peers’.
Positive interventions (II)
Non-time limited support/different outcomes
for some older people can be important.
 For those who are drinking at risk, abstinence may
not be required; for those with long-term
problems, this may not be a realistic goal.
 BUT – flipside can be ‘dangerous myth’ that
recovery doesn’t apply to older people.
 Majority of older people with alcohol problems
not dependent, but drinking at risk.
 Brief interventions can be delivered by GPs; other
health and social care professionals well-placed to
do this, too (e.g. those working in older people’s
mental health services, in residential services and
for social care providers).
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Email: gemmal@drugscope.org.uk
www.drugscope.org.uk