Psychiatrists call for action to tackle substance misuse in older people

Embargoed until Wednesday, June 22, 2011

The NHS must wise up to the “growing problem” of drug and alcohol misuse among older people, according to a new report published today by the Royal College of Psychiatrists.

The report, written by the Older People’s Substance Misuse Working Group of the Royal College of Psychiatrists, warns that not enough is being done to tackle substance misuse in our aging population – making them society’s “invisible addicts”.

The report pulls together evidence to highlight the extent of the problem:

• The number of older people in the UK population is increasing rapidly – between 2001 and 2031 there is predicted to be a 50% increase.
• A third of older people with alcohol use problems develop them in later life – often as a result of life changes such as retirement or bereavement, or feelings of boredom, loneliness and depression.
• Older people often show complex patterns and combinations of substance misuse e.g. excessive alcohol consumption as well as inappropriate use of prescribed and over the counter medications.
• Although illegal drug use is uncommon among over-65s at the moment, there has been a significant increase in the over-40s in recent years. The problem is likely to get worse as these people get older.

Professor Ilana Crome, Professor of Addiction Psychiatry and Chair of the Working Group, said: “The traditional view is that alcohol misuse is uncommon in older people, and that the misuse of drugs is very rare. However, this is simply not true. A lack of awareness means that GPs and other healthcare professionals often overlook or discount the signs when someone has a problem. We hope this report highlights the scale of the problem, and that the multiple medical and social needs of this group of people are not ignored any longer.”

The Working Group makes a series of key recommendations including:

• GPs screen every person over the age of 65 for substance misuse as part of a routine health check.
• The government issues separate guidance on alcohol consumption for older people. Current recommended ‘safe limits’ are based on work in younger adults. Since there are physiological and metabolic changes associated with aging, these limits are too high for older people. Evidence suggests the upper ‘safe limit’ for older men is 1.5 units per day or 11 units per week, and for women 1 unit per day or 7 units per week.
• Public health campaigns around alcohol and drug misuse are developed to specifically target at older people. 
• All doctors, nurses, psychologists, social care workers and allied health professionals are given suitable training in substance use disorders in older people.

There is accumulating evidence that the treatment for alcohol and drug misuse in older people is effective and that older people often stay in treatment for longer than younger people.

Dr Tony Rao, a consultant in old age psychiatry and member of the Working Group, said: “We are witnessing the birth of a burgeoning public health problem in a ‘baby boomer’ generation of older people for whom alcohol and drug misuse is growing. There is a pressing need to meet this need with primary, secondary care and tertiary care services that can offer timely and effective detection, treatment and follow up for a large but hidden population.”

Dr Owen Bowden-Jones, Chair of the Royal College of Psychiatrists’ Faculty of Addictions Psychiatry, said: “Because of the pre-conception that alcohol and drug use are problems of the young, there is a generation of older people for whom these problems have gone undetected. This timely report is a wake-up call for healthcare professionals and a reminder that older people have particular risks for substance misuse. Our challenge is to improve the detection of these invisible addicts and offer the treatments which we know can transform people's lives.”

Dr Stefan Janikiewicz, a general practitioner and member of the Working Group, said: “In primary care there is increased pressure to glean information from patients and act on these findings. Smoking and alcohol are still the most common forms of substance misuse that affect all age groups. Increasingly, GPs are responding to these issues. However, management of this demanding workload requires the support of specialist services and other agencies.”

Don Shenker, Chief Executive of Alcohol Concern, said: “While younger excessive drinkers often make the headlines, we should remember that older people often turn to alcohol in later life as a coping mechanism and this can remain stubbornly hidden from view. This report calls for much greater recognition that excessive drinking in older age is both widespread and preventable, particularly if public health professionals are supported and trained to spot the signs and take appropriate action.”

References:

College Report 165: Our Invisible Addicts is published on 22 June 2011. It is the first report of the Older People’s Substance Misuse Working Group at the Royal College of Psychiatrists, which has representation from addiction psychiatrists, old age psychiatrists, general practitioners and substance misuse charities.