Aging with drugs: a hidden reality

Aging with drugs: a hidden reality

More and more older people are struggling with addiction to alcohol or other drugs, but few services are tailored to their needs

Dependency in the elderly

Addiction among older adults is often accompanied by stigma, leading to feelings of shame, guilt and isolation, and making it more difficult for them to seek help and recover. Image from Dianova’s LNOB campaign adapted from a photo by Towfiqu barbhuiya on Unsplash

By the editorial team – Dependency affects everyone, regardless of age, but older people are often more vulnerable than others due to loss of autonomy, the prevalence of chronic and painful diseases, life events marked by bereavement or a lack of attention to their specific needs.

It is only recently that health care practitioners and researchers Researchers have begun to focus on drug use and addiction in older adults, having previously focused primarily on the younger adult age group. As baby boomers reach age 65, substance use disorders and other addictive disorders are on the rise, in part because of past use: These populations are aging, but they are maintaining their lifelong patterns of alcohol and other drug use.

In Western countries, baby boomers are reaching the age of 65 and over. They consume alcohol and other drugs much more than their parents. The drug addiction field was not ready for this.

Increase in drug use among older people

One of the first international reports to address this issue was published in 2021 by the International Narcotics Control Board (United Nations). The first chapter, entitled “A Hidden Epidemic: Drug Use Among Older People”outlines the problem of the ageing population across the world (according to the UN, 703 million people were aged 65 and over in 2019, and this figure is expected to double to 1.5 billion by 2050), before highlighting the increase in drug use and related deaths, as well as drug-related disorders among older people.

This increase is mainly affecting high-income countries and is explained in particular by the aging of the baby boom generation, i.e. people born between 1946 and 1964, a period of high birth rates at a time when drug use was beginning to reach relatively high levels. The report also highlights that this upward trend will continue in the coming years, with the retirement of the last baby boomers (not to mention Generation X or the Millennials who will follow).

From an epidemiological point of view, another important problem is the increase in the consumption of legal substances among the elderly, especially highly addictive hypnotics and opioid analgesics. This is largely due to the hypermedicalization of the elderly, the essentially biomedical approach to treatment and the lack of economic and human resources necessary to adequately address the social determinants of diseases in the elderly.

This results in at least two profiles of older people who use drugs: those who have aged with drugs and those who have started using legal drugs because of the psychosocial problems associated with aging.

As the report shows, however, this reality remains largely hidden because epidemiological studies tend to focus on the general population aged 15 to 65 or on adolescents, young adults and marginalised and vulnerable groups.

This is reflected in the gaps in the scientific literature and in the prevailing attitudes of society as a whole towards older people. Finally, although the problem of psychoactive substance use among older people is beginning to be recognised as such, the lack of information and data means that much remains unknown about the real challenges faced by those affected themselves.

Smiling old woman

Social isolation is likely a major factor in the underrecognition and underreporting of problematic substance use among older adults. Older adults may not have the same level of social support or may be more likely to hide their addiction due to stigma or shame. Photo by Ravi Patel on Unsplash

Older people are more vulnerable to dependency

While illicit drug use tends to decrease with age, addiction is a reality among older people, although it often takes different forms than in younger people. Aging brings major physiological changes: the brain becomes much more sensitive to the effects of alcohol and other drugs, with consequences for health. In addition, addiction among older people has a major impact on their social environment, their relationships with family and friends, and their participation in community life.

In fact, aging is a period of great fragility, which leads to vulnerability to addictions.

This fragility is particularly linked to the awareness and perception that older people have of themselves and of the way they are perceived by others. It is also necessary to take into account the progressive loss of cognitive and motor abilities, which leads to emotional vulnerability and reduced autonomy in daily life, not to mention a much greater risk of falling after even moderate alcohol consumption.

Finally, social, emotional, and mental health factors are equally important. For example, the loss of meaningful relationships, feelings of boredom, or a loss of social usefulness can overwhelm older adults after retirement, leading them to feel like a real or imagined burden to others and to lose self-esteem. Older adults are also at risk of becoming increasingly socially isolated, particularly after estrangement from family or the death of a partner, a phenomenon that partly explains the high prevalence of depression among older adults.

Helping people age well through tailored addiction care

Caring for older people with drug problems is primarily about meeting their specific needs, but it also presents unique challenges.

Health professionals lack tools specifically designed for older adults, making it more difficult to identify at-risk substance use problems, or substance use disorders (SUDs), especially since older adults are less likely to view substance use as a problem and therefore seek appropriate support.

Additionally, these same professionals may not have the training to recognize the signs associated with these problems or may interpret them as symptoms of aging. Nevertheless, drug use and other addictions among older adults are growing problems that require a thorough understanding of the unique challenges associated with this stage of life. That is why we must ensure that addiction care is tailored to meet these challenges.

The “Leave No One Behind” campaign calls on public authorities to invest more in this area

In particular, it is essential to:

  • Investing in training health professionals – they may confuse symptoms of substance use disorder with those of other chronic illnesses or with those of natural age-related changes;
  • Improving access to services by changing the way health care is paid for by insurance companies and facilitate access for the elderly who often lose their autonomy;
  • Increase the visibility of drug addiction and problematic drug use in the elderly;
  • Promoting a better understanding of dependency in older people:older people are often reluctant to seek treatment because of the stigma associated with simply using drugs and not fulfilling the role expected of them as they age;
  • Promote research for develop screening methods for older people and more effective intervention strategies which take into account their specific characteristics and needs;
  • Implement comprehensive treatments that address social problems without over-prescribing medications. The hypnotics and opioid painkillers prescribed to so many older people are highly addictive. We must end the medicalization of social problems such as loneliness, poverty and social isolation.