Growing Old with Drugs: A Hidden Reality

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 – Dianova’s LNOB campaign’s image adapted from photo by Towfiqu barbhuiya on Unsplash

By the Editorial team – Addiction affects everyone, whatever their age, but older people are often more vulnerable than others because of loss of autonomy, the prevalence of chronic and painful conditions, life events marked by bereavement, or a lack of attention to their specific needs.

• Leave No One Behind – View Dianova’s new campaign’s page
• Yes, Older People Can Be Stigmatized Too! – Read article
• Addiction Among Older Adults: A Hidden Reality– Read article by UNAD

It is only recently that health care practitioners and researchers have begun to take an interest in the issue of drug use and addiction among senior citizens, having previously focused largely on the young adult age group. As the baby boomers reach 65 years of age, substance use disorders and other addictive disorders are on the rise, not least because of past use: these populations are ageing, but they are retaining the habits of alcohol and other drug use that they have had all their lives.

Increase in drug use among senior citizens

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: the use of drugs among older persons“, outlines the problem of an ageing population across the globe (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 mainly affects high-income countries and can be explained in particular by the ageing 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 began to reach relatively high levels. What’s more, the report points out that this upward trend will continue over the next few years as the last of the baby boomers retire (not to mention Generation X or the Millennials who will follow).

From an epidemiological viewpoint, another relevant issue is the increase in the use of legal substances among older people, especially highly addictive hypnotics and opioid analgesics. This is largely due to the hyper-medicalization of older people, to the essentially biomedical approach to treatment, and to the lack of economic and human resources needed to adequately address the social determinants of older people’s ailments.

As a result, there are at least two profiles of older people who use drugs: those who have grown old with drugs, and those who have started using legal drugs because of the psychosocial problems associated with ageing.

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

This is evident 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 substance use among senior citizens is beginning to be recognized as such, the lack of information and data means that much remains unknown about the real challenges faced by the people concerned themselves.

Social isolation is probably a major factor in under-recognition and underreporting of problem substance use in elderly people. 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 addiction

While the use of illegal drugs tends to decrease with age, addiction is a reality among older people, although it often takes a different form to that of younger people. Ageing brings about major physiological changes: the brain becomes much more sensitive to the effects of alcohol and other drugs, with consequences for people’s health. What’s more, addiction in older people has a major impact on their social environment, their relationships with family and friends, and their participation in community life.

This fragility is particularly related to the awareness and perception that older people have of themselves and the way they are perceived by others. We must also take into account the gradual loss of cognitive and motor skills, which leads to emotional vulnerability and a reduced level of autonomy in their 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 of a loss of social usefulness can overwhelm older people after they have retired, potentially leading them to feel as a real or imagined burden on others and a loss of self-esteem. Older people are also at risk of becoming increasingly socially isolated, particularly following the estrangement of one’s family or the death of a partner, a phenomenon that partly explains the high prevalence of depression among the elderly.

Helping people to age well through appropriate addiction care

Caring for older people with drug problems is primarily a matter of meeting their specific needs, but it also presents some particular challenges.

Furthermore, these same professionals may lack the training that would enable them to recognize the signs associated with these problems or they may interpret them as symptoms of ageing. Nevertheless, drug use and other addictions among older people are growing problems that require an in-depth understanding of the unique challenges associated with this stage of life. That’s why we need to 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:

• Invest in training for health professionals – they may confuse the symptoms of SUD with those of other chronic conditions or natural age-related changes;
• Improving access to services by changing the way healthcare is paid for by insurance companies and making access easier for older people who often lose their autonomy;
• Increasing the visibility of addiction and problem drug use among older people;
• Promoting a better understanding of addiction among older people: older people are often reluctant to seek treatment because of the stigma attached to simply using drugs and not playing the role expected of them as they age;
• Promote research to develop screening methods for older people and more effective intervention strategies that take into account their specific characteristics and needs;
• Implement comprehensive treatments that address social problems without over-prescribing drugs. The hypnotics and opioid analgesics prescribed to so many older people are highly addictive. We must stop the medicalization of social problems such as loneliness, poverty and social isolation.