Wednesday, August 23, 2017

Concerns over rise of substance misuse in baby boomers

Consultant old age psychiatrist at South London and Maudsley NHS Foundation Trust, Dr Tony Rao, has raised concerns over a rise in alcohol and drug misuse among the over 50s, commonly known as “baby boomers”.

He has published an editorial in the British Medical Journal (BMJ) with Flinders University in Australia. It says the number of people aged over 50 experiencing problems from substance misuse is growing rapidly, with the numbers receiving treatment expected to treble in the United States and double in Europe by 2020. The editorial calls for a coordinated international approach to tackle this rapidly growing problem.

Dr Rao explains: ‘Within our old age psychiatry services at South London and Maudsley NHS Foundation Trust we are improving the detection of drug and alcohol misuse in patients with mental health problems. By doing this we are then better able to address problems earlier and refer to specialist services if needed.’

In both the UK and Australia, risky drinking is declining, except among people aged 50 years and older, the authors explain. There is also a strong upward trend for episodic heavy drinking in this age group.

But this generational trend is not restricted to alcohol, they add. In Australia, the largest percentage increase in drug misuse between 2013 and 2016 was among people aged 60 and over, with this age group mainly misusing prescription drugs.

However, people over 50 also have higher rates than younger age groups for both past year and lifetime illicit drug misuse (notably cannabis).

With alcohol being the most common substance of misuse among older people, under-detection of alcohol problems is of immediate concern - and may increase further as baby boomers get older because of their more liberal views towards, and higher use of, alcohol, they write.

A lack of sound alcohol screening to detect risky drinking may result in a greater need for treatment, longer duration of treatment, heavier use of ambulance services, and higher rates of hospital admission.

Research suggests that treatment programmes adapted for older people with substance misuse were associated with better outcomes than those aimed at all age groups.  

However, the authors point out that clinicians will need improved knowledge and skills in assessing and treating older people at risk of substance misuse.
“There remains an urgent need for better drug treatments for older people with substance misuse, more widespread training, and above all a stronger evidence base for both prevention and treatment,” they write.

“The clinical complexity of older adults with substance misuse demands new solutions to a rapidly growing problem. So far, there has been little sign of a coordinated international approach to integrated care,” they conclude.

Read the BMJ editorial



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