In both Europe and North America increasing numbers of older people are misusing legal substances, including prescription and over the counter medications, as well as consuming more than the recommended amounts of alcohol. Indeed, research shows that the number of people aged over 50 with substance use disorder in the USA is likely to double between 2000 and 2020. The pharmacokinetic and physiological vulnerability with increasing age makes older people at greater risk from the impact of prescribed medications and other substances. Even the medicinal use of alcohol may be detrimental to health and social function in older people. A recent study in Age & Ageing found that older people who used alcohol for medicinal purposes, reported a higher prevalence of forgetting to take daily medication, fractures in adult life and falls in the previous six months. A key issue is that older people themselves, their families, carers and some healthcare professionals are either unaware of or in denial of substance misuse.
Professor Peter Crome, past President of the BGS, said: “The recent Royal College of Psychiatrists report Our Invisible Addicts, which examined the nature and extent of substance misuse in older people raised questions about service provision. The Equality Act 2010, makes it a legal obligation for the NHS to provide older people with the same level of healthcare provision, including assessment and treatment, as younger people. To this end, all healthcare professionals must take addiction in older people more seriously. Many think that nothing can be done to alter the course of addiction. This is simply not the case. In fact, research shows that treatment for older people produces results similar to, and sometimes superior to, younger people.”
Services with which older people with substance problems come into contact – including addiction, mental health and general medical services – should be “older-person” friendly. The editorial clarifies that this should include physical access, referrals, facilities and patient information. Substance use can contribute to complex presentations in older people, including unexplained falls, changes in eating patterns, weight loss, irritability and agitation. Furthermore, assessment and discussion of substance use needs to be routine rather than sporadic when older people come into contact with primary or secondary care professionals. All healthcare professionals in contact with older people should have training in how to use appropriate assessment tools and need to be wary of attributing alcohol and drug misuse to other physical and mental disorders. Assistance to approach specialists for appropriate treatment interventions can be vital.
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Notes to Editors
1. Age and Ageing is an international journal publishing refereed original articles and commis sioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life. It is the official scientific journal of the British Geriatrics Society and is published by Oxford University Press.
2. The editorial, Addiction And Ageing – Awareness, Assessment, And Action, was written by Professor Ilana B Crome, Professor Peter Crome and Rahul Rao and first published online on 17 October 2011.
3. The British Geriatrics Society (BGS) is a membership association of doctors, nurses, therapists, scientists and others with a particular interest in the care of the frail older person and in promoting better health in old age. The BGS strives to promote better understanding of the healthcare needs of older people and to share examples of best practice to ensure that older patients are treated with dignity and respect by all clinical staff they come into contact with.
4. Our Invisible Addicts was published by the Royal Society of Psychiatrists in June 2011.