The Forgotten People: Drug Problems in Later Life
This study is about older people with drug problems. Older people, like younger people, use a variety of drugs from cannabis to heroin. Some older people develop a drug problem for the first time in later life whilst others have a lifelong history of drug problems. Older people use drugs for a variety of reasons including enjoyment, to cope with difficult problems, situations or feelings or they may inadvertently become addicted to medicines that they took as instructed by a doctor. Drug misuse can lead to social, financial, psychological, physical and legal problems for older people. It can reduce their quality of life, cause significant distress to their families and carers and lead to increased health and social care costs.
In March 2014, the Big Lottery Fund (the FUND) commissioned the Substance Misuse and Ageing Research Team (SMART) at the University of Bedfordshire to carry out a short scoping study to provide:
- An overview of the scale, nature and consequences of drug misuse in older people across the UK.
- An understanding of the extent to which substance misuse strategies in the four UK countries address the issue.
- Guidance on what action is most needed and where investment from independent and statutory funders might be most useful.
This report combines statistical data, published research and the views of professionals. Quotes from professionals interviewed during this study are included in boxes throughout the report.
The study is about ‘older people’ but when does a person become ‘old?’ Chronological age is not a precise marker for changes that accompany ageing, there are dramatic variations in health status, levels of participation and independence amongst adults of the same age (World Health Organisation, 1999). The National Service Framework for Older People (Department of Health, 2001), rather than labelling people by chronological age, distinguishes older people who are:
- Entering old age: These are people who have completed their career in paid employment and/or child rearing. This is a socially constructed definition of old age, which, according to different interpretations, includes people as young as 50, or from the state pension age, which is currently between 61 and 68 depending on when someone was born and if they are male or female. These people are active and independent and many remain so into late old age.
- Transient phase: This group of older people are in transition between healthy, active life and frailty. This transition often occurs in the seventh or eight decades but can occur at any stage of later life.
- Frail older people: These people are often vulnerable as a result of health problems such as stroke or dementia, social care needs or a combination of both.
In the substance misuse research literature, the age cut-off for an ‘older’ drug user can be as low as 35 years (e.g. Shaw, 2009). This may be partly due to the common age bias that drug problems occur in the young but not the old. Others have argued that the ageing process among older people with chronic drug problems can be accelerated by at least 15 years (Beynon et al., 2009). The difficulty is that using low age cut-offs creates even more heterogeneity in what is already a diverse group and someone in their 30’s or 40’s is likely to have very different life circumstances and needs to someone in later life. Therefore, for the purposes of this report, we have included people aged 60 and over in the older age group. In some cases, where we use information provided by others, we have had to include people below 60 years of age.
There are nearly 14.5 million people in the UK aged 60 and over (Office for National Statistics, 2013a), more than the number of people aged under 18 (Office for National Statistics, 2011a). The number of people in this age group is expected to pass the 20 million mark by 2031 (Office for National Statistics 2011b) and within 70 years, 1 in 3 people in the UK will be aged 60 or over (Office for National Statistics, 2009). This population is becoming more ethnically diverse as people from black and ethnic communities who came to Britain in the 1950’s, 60’s and 70’s become older (Age UK, 2014).
Older people with drug problems in the UK fail to get the same attention as young people, yet preventing, detecting and addressing problem drug use in older people is just as important. There are a number of age-related factors that mean that older people as a group have specific needs and vulnerabilities that require special consideration and some of these are illustrated in Figure 1. It is vital that prevention, detection and treatment strategies are sensitive to the needs of older people and the diversity within the ageing population. Identification and delivery of age-appropriate drug prevention, treatment and support provides an opportunity to help improve overall health and quality of life for older people, enable them to maximise their potential and reduce the costs and wider impacts on society.
Having briefly outlined the context, this report will now move on to explore the extent, nature, trends and consequences of illicit drug use and medication addiction in older people. There will then be a consideration of what can be done in terms of prevention, identification, treatment, harm reduction and ensuring that older people with drug problems receive adequate social care. Next, substance misuse strategies from the four UK countries will be reviewed to see to what extent they acknowledge and address the age-related needs of older people. The report concludes with six key priorities for funders that have emerged from this study.