In Mad Men, Don Draper was seldom seen without a drink. Photograph: Michael Yarish/AP
never touched a drop in my life. Now, it’s all I’ve got.” One of my first referrals as a consultant old-age psychiatrist was a woman with anxiety who began drinking after her husband died. Grief at losing her partner pulled her into a deep depression. Alcohol eased the pain. It became all she could think about. Her life revolved around buying and consuming drink; dependence on alcohol to soothe her sorrow developed into an addiction.
When we say “addict”, we rarely think of people aged over 65. You might think this is uncommon. It isn’t. People expect to live longer, so they’re not slowing down just because they’re in their 60s. It shouldn’t be a surprise that we are seeing substance misuse, dependence and addiction in older people: think how many old fashioneds Don Draper got through in each episode.
We are woefully unprepared to meet the needs of older people struggling with substance misuse. So what will happen in 2030, when members of Generation X – the twentysomethings who popped pills at warehouse raves in the 1990s – start to turn 65? Addiction in older age is not a problem that’s going to go away. By 2030, nearly a quarter of the population in England will be over 65. That’s around 12 million people. We’re sitting on a ticking time bomb, waiting for the inevitable fallout of each generation overindulging in its substance of choice.
We can’t ignore substance misuse in the over-65s. Compared to previous generations, older people have higher rates of drinking above recommended guidelines, higher rates of alcohol-related deaths and higher rates of alcohol-related admissions to hospital. ONS figures show that while the rest of the population has reduced its weekly alcohol intake, those aged 65 to 74 continue to drink at similar levels, exceeding recommended guidelines.
Lifetime use of cannabis and cocaine in 65- to 74-year-olds increased seven-fold and five-fold respectively between 2000 and 2014. In the last 10 years, the number of people in that age group admitted to hospital for drug-related mental health problems, such as psychosis, rose from 181 to 1,345. Use of prescription drugs for pleasure is also on the rise in older people, with opiates and medication for insomnia often used for non-medical reasons. As addiction services are being dismantled, more baby boomers with illicit drug misuse are entering old-age psychiatry services. Snorting cocaine, smoking cannabis or experimenting with psychoactive substances shouldn’t raise the eyebrows of psychiatrists providing care in older people’s mental health services, but even I initially failed my MRCPsych exams for lacking the necessary expertise on substance misuse. I didn’t realise how central it was to old-age psychiatry.
We wrongly assume that substance misuse is a younger person’s problem and there are huge challenges in increasing access to services for older people because of this.
When they do, they need care that not only addresses misuse, but takes into account chronic physical health problems and mental health conditions such as dementia. Treatment also has to manage the normal physical pain of ageing and the unfortunate truth of social isolation and bereavement.
Sadly, I see a future in which poly-substance misuse in older people is common. We have a lot of catching up to do to provide services for substance abuse beyond alcohol and tobacco. Baby boomers are the generation that laughed off inebriation, saw alcohol advertised daily on television and thought relaxation was more about smoking a joint than mindfulness.
But at what age do we assume people “grow out” of the pub night three times a week or smoking cannabis? The “you’re only young once” approach can easily go from a relaxed attitude in middle age to dependence and addiction in older life.
Substance misuse in the over-65s may seem strange because we characterise older people as fusty, but it’s not surprising that the attitudes of youth carry into later life. If we continue to ignore substance misuse in people over 65, we are closing the door on ensuring their quality of life as 70, 80 or 90-year-olds. In 2017, that door is still barely ajar.
Dr Tony Rao is consultant old age psychiatrist at the Royal College of Psychiatrists