W.When I joined a community elderly mental health team 20 years ago, addiction was not a central part of our work. One of our first referrals was for an alcoholic patient who was about to be evicted. It was rejected – it wasn’t relevant to our ministry, at least I thought. But over the years referrals kept coming in, combining social problems and addiction. We’d send the problems back to the GP, but the same patients were referred years later for depression and dementia. Her problems were not gone; if anything, they had deteriorated.
It was a healing lesson that led me to join a group of professionals and delve deeper into the problem of drug and alcohol addiction in the elderly. When we examined the data, a pattern of substance abuse emerged among those born between 1946 and 1964: the so-called “baby boomers”. Their higher rates of addiction than the older or younger generations are returning, which has implications for public health and clinical services.
A new analysis of the NHS numbers shows that the number of elderly people using addiction care has drifted away from other age groups at an alarming rate. Cannabis remains the most widely consumed illicit drug, with the number of people aged 55 and over who are cared for by drug treatment services increasing by nearly 800% over the past 15 years – and more than 1,000 for those over 65 %. This contrasts with a decline of more than 25% among 18 to 19 year olds. But it doesn’t stop there. For alcohol, opioids, cocaine, crack and amphetamines, the number of 18 to 19 year olds on addiction care fell by more than 25%, compared with an increase of more than 200% for 55 year olds. and over group over the same period.
There are many reasons for this trend. Baby boomers were much more exposed to alcohol commercials in their youth, non-drink contacts were viewed crookedly, and there was a more lenient attitude towards “recreational” drug use, with little awareness of the potential harms of drugs like cannabis. As they got older, this age group also consumed fewer drugs and alcohol than previous generations. In fact, some people may even have cut earlier just to increase their consumption in retirement. And their problems can be masked. One of my patients presented with recurring falls until after a year she told me that she drank half a bottle of whiskey a day. A male patient of mine complained of constant fatigue and poor sleep until he told me he smoked cannabis four times a week. In this regard, it is encouraging that the numbers suggest that more elderly people are seeking help.
For years I have been processing data on drug and alcohol consumption by older people and submitting them to politicians. Some of these efforts have borne fruit. The Drink Wise Age Well project, funded by the Big Lottery £ 25 million, provided an evidence base of what can be done to prevent, protect and intervene in the physical, psychological and social harm of alcohol in the elderly.
Older people’s drug addiction is still under the radar, however. In 2019, a letter from the Drug Abuse Council to then Interior Minister Sajid Javid drew attention to the needs of an aging cohort of drug users. The Council recommended that “special attention should be paid to the availability and knowledge of staff to address the complex physical and mental health problems of older drug users”. But in the second part of Dame Carol Black’s Independent Review of Drugs, the elderly stood out for their absence.
We ignore the surprising trend in treating drug and alcohol addiction in the elderly at your own risk. Older people not only have pronounced problems that reflect the physical and psychosocial consequences of aging, but are also at risk of pronounced mental disorders such as alcohol-related dementia. Looking ahead, truly integrated care will mean joining together public health services and the NHS to rebuild addiction services. This will come at a price, but one that will no doubt improve the lives and livelihoods of our invisible addicts.