Substance misuse in older people: Baby boomers are the population at highest risk

October 2017
Rao, R. and Roche, A. (2017). Substance misuse in older people: Baby boomers are the population at highest risk. BMJ, 358 (j3885).

Advances in medicine mean that people are living longer. At the same time however, the number of people aged 50+ experiencing AOD problems is also increasing rapidly.

What the study found

A recent examination of Australian and British data found that risky drinking is declining in all age groups except among people aged over 50. The 2016 National Drug Strategy Household Survey (NDSHS) also found that, in Australia, from 2013 to 2016 the largest increase in drug misuse was among people aged 60 and over. The key drug of concern was prescription drug misuse.

Contrary to popular belief, people aged 50+ also had higher rates of recent (in the past 12 months) and lifetime rates of illicit drug (mainly cannabis) use compared to younger people.

One of the other key concerning findings from this study was that an increasing proportion of women are drinking later in life. This drinking is often brought on by a range of life events such as retirement, the loss of a loved one and/or friends, changes to their living arrangements, less frequent contact with family and friends and overall social isolation.

The study also identified that older people use AOD in different ways and for different reasons and this in turn has implications for assessment, intervention and treatment. A typology of older AOD shows that they generally fall into one of three groups:

  • Maintainers – unchanged patters of AOD use over their lifetime
  • Survivors – long-term problematic AOD use
  • Reactors – later uptake or increased patterns of use.

Two systematic reviews of descriptive and analytical trials found that:

  • Treatment programs adapted for older AOD users have better outcomes than programs designed for all age groups
  • Assessment, treatment and recovery plans need to consider age-specific clinical needs
  • Professionals need to consider the possibility of coexisting mental disorders e.g., cognitive impairment and depression and complex physical morbidities.

Implications for future healthcare

Older people with AOD problems currently present a number of challenges for service providers which will continue to grow into the future if they are not adequately addressed. These challenges and potential solutions include:

  • An urgent need for better drug treatments for older people with AOD problems to address comorbid AOD and mental and physical health problems
  • A stronger evidence base for prevention and treatment.