Older adults: RCP urges action for 'Our invisible addicts' 2018

The Royal College of Psychiatrists (RCP) has released an updated report on substance misuse problems amongst older adults, calling for further training, treatment investment and policy recognition of the complex issues involved.

Download the full document 'Our invisible addicts' [pdf] here.

The report updates a previous publication by the RCP in 2011 which advised people over 65 should not drink more than 1.5 units of alcohol a day - around half the former daily recommended guidelines - based on physiological and metabolic changes associated with ageing.

The RCP say that since 2011, whilst awareness of the clinical and public mental health aspects of substance misuse in older people has increased, so has the level of problems as 'the population of “baby boomers” ages, increasing both the number of older people and the percentage of the older population with experience of substance misuse'. 

Despite an overall fall in alcohol consumption since 2004, consumption has been rising amongst older adults, as have alcohol-related deaths - up 45% since 2001. National alcohol-related hospital admissions are also yet to decline, with admissions highest amongst those around retirement age. Dr James Nicholls, as reported in the Guardian said “a heavier-drinking postwar generation is now reaching an age where accumulated alcohol harms start to have a real impact", whilst RCP lead Dr Tony Rao highlighted to the Independent the need to recognise that “in the 21st Century, substance misuse is no longer confined to younger people".

Indeed increasing attention to the issue of older adults and the 'baby boomer' generation has been made in recent years. The 'Drink Wise, Age Well' initiative was established following an award of £25 million lottery funding in 2014 and has released a series of reports exploring alcohol use amongst the over 50s, older adults and the labour market, and has been delivering a range of local initiatives to 'help people make healthier choices about alcohol as they age'.

However research has revealed the extent to which older adults are often overlooked or even illegally excluded from treatment and support. A recent report found that 75% of residential rehabilitation centres had arbitrary upper age limits and had limited or no disabled access, and follows a series of previous calls to end stigmatization of older adults with alcohol problems  and limited service access.

The RCP report therefore calls for increased multi-professional responses that include psychiatry, nursing, pharmacy, occupational therapy, psychology, social work and the voluntary sector (including peer support). Writing in a recent Faculty of Public Health alcohol edition [pdf], Dr Tony Rao states the challenge is to 'manage this complexity in a way that also looks at age sensitive matters in service delivery, such as sensory and cognitive impairment, mobility problems, dignity and stigma' and 'it often seems that older people with alcohol problems are at the bottom of the commissioning ladder.'

A recent systematic review identified limited evidence to draw on, but still that 'older adults appear to respond well to interventions aimed at reducing alcohol consumption'. Many may note that addiction services and the range of wider health and social care budgets are facing ongoing cuts. Calls to invest in further care and support for older adults with alcohol and substance-related problems are likely to continue for some time yet.