Ahead of the joint international symposium hosted by the European Association of Geriatric Psychiatry and the American Association for Geriatric Psychiatry on Tuesday 7th December, guest speaker Dr Tony Rao (Consultant Old Age Psychiatrist) shares why the hidden addictions in older people pose a healthcare crisis around the world.
1964 was the year that the youngest members of the “Baby Boomer” cohort were born. Ironically, it was also to be the year when Professor Sir Martin Roth – first President of the Royal College of Psychiatrists – wrote an article entitled Psychiatric Aspects of Middle Age. In it, he stated “Middle age is also the time when social drinking merges insensibly with the early manifestations of chronic alcoholism. It may be many months before the store of gin bottles is discovered in the kitchen cupboard. In any event, in no case with a decline in memory for recent events, an unexplained attack of delirium or hallucinosis or a change in personality, should the possibility of alcoholism fail to be considered”.
Perhaps we owe it Sir Martin for being a true visionary in his formulation that alcohol addiction in older people may so easily be missed. Fast forward over half a century and we find that over the past 15 years, it is older and not younger people who have shown higher rises in rates of drug and alcohol misuse. It is a population with higher longevity than 50 years ago, but one that comes at cost. That of living for longer with drug and alcohol-related disability.
Older people present unique challenges to clinical services. It is a population with rich life experience but with complex health needs that include chronic medical disorders, many of which may have developed from the effects of drug and alcohol addiction. The same can be said for mental disorders such as anxiety, depression, other mental health consequences of early and later life trauma. Even dementia.
Drug and alcohol addiction has implications that ripple across the whole biopsychosocial spectrum and where interventions range from detoxification to motivational interviewing to an integrated community reinforcement approach that fosters recovery. But presentations are often both complex and non-specific and include insomnia, impaired concentration, self-neglect, restlessness, persistent tiredness, unexplained nausea and vomiting and unexplained falls
When it comes to screening for alcohol misuse, different tools are needed, such as the Short Michigan Alcoholism Screening Test-Geriatric version. This taps into problems more commonly seen in older people, such as ‘drinking after a significant loss’ or ‘drinking to take your mind off your problems to improve screening sensitivity. Alcohol related cognitive impairment is another example of the choice of screening tools is paramount – using the Montreal Cognitive Assessment rather than Standardised Mini Mental State Examination can make the difference between intervention and indifference. But this is just the start of a process where screening should be supplemented by collateral information from families, carers, family doctors, hospital discharge summaries, home carer reports, day centre reports, reports from housing officers/wardens of supported housing, criminal justice agencies and results from previous investigations such as psychometry and neuroimaging. Putting this jigsaw together is critical to offering interventions that can improve independence and reduce harm. Pharmacological approaches to treatment also differ for older people living with drug and alcohol addiction. For example, a lower starting dose of chlordiazepoxide is advised and shorter-acting drugs reduce the risk of accumulation.
But that’s still not all. There are legal and ethical considerations such capacity, consent and the principles used to determine the best interests. Social justice also features heavily in that older people from black and minority ethnic backgrounds face major challenges in accessing drug and alcohol services. These may include language barriers, social stigma as well as cultural and family values. Each racial/ethnic group is not homogeneous and may include many subcultures that may be influenced by cultural values such as traditional beliefs, family structure, lifestyle preferences, gender roles, degree of assimilation, and religious beliefs. These need to be borne in mind by various health professionals for culturally appropriate service delivery.
With drug and alcohol addiction in baby boomers across the globe hiding in plain sight, we need a concerted effort to improve prevention, workforce development, service provision and integrated care to influence policy and practice. Which is why experts from around the world have been brought together on one virtual stage to offer unique insights into research, policy and best practice.
We hope to see you there.
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Join the European Association of Geriatric Psychiatry and the American Association for Geriatric Psychiatry for:
International symposium: Addictions in older people
Tuesday 7th December 2021, 14.00 – 18.25 (GMT)
Online: MS Teams
Cost: £60.00 - EAGP and AAGP members / £75.00 - all non-members