Taking the lead from Wales

Posted 08.03.2017

Substance misuse in an ageing population

Our colleagues in Wales, have for some time, demonstrated a strong commitment to responding to substance misuse in an ageing population. Indeed the Substance Misuse Strategy for Wales 2008-2018 has a section on the needs of older adults and a specific Substance Misuse Treatment Framework; Improving Access to Substance Misuse Treatment for Older People has been developed by the Welsh Government .  Now a recent report from the Advisory Panel on Substance Misuse (APoSM) further focuses on best practice in service design and strategic responsibilities in supporting ‘Substance Misuse in an Ageing Population’

The report rightly recognises some key distinctions in this population. The proportion of ‘the older population in Wales is projected to rise to 41 per cent by 2020’, and this population are ‘more likely than earlier generations to develop substance misuse problems – meaning greater demands on health, social care and other services’. The report recognises that that there is a growing older generation in the prison population, who will have substance misuse problems that are not being adequately met. In the general population, older adults are more likely than any other age group to exceed recommended alcohol limits, and drink everyday. The report states ‘alcohol-related deaths in older populations are increasing in Wales, with fibrosis and cirrhosis of the liver and alcohol related liver disease the two main causes of death’. Finally, referrals to substance misuse services are increasing in the over 50s population more than any other group. Whilst in some respects, this is a positive thing in that screening and identification of substance misuse issues may be improving in this population, it may also be indicative of a growing problem in this age group.

Considering the needs of an ageing population

The APoSM report in response to these issues makes some very timely recommendations that we at Drink Wise, Age Well would like to see adopted across the four nations. Firstly in order to understand prevalence levels and the needs of this population more, it is vital that all reporting data that covers substance misuse removes any  cut off ages and has more detailed age breakdown than grouping 60 +, 65+ or 75+ together .  Healthy ageing strategies should consider the impact of alcohol on health and well-being and likewise, all substance misuse strategies  to consider the needs of an ageing population. Service design should ensure it is accessible and age appropriate, this may include providing home visits and age appropriate screening, assessment  and interventions . More generic older adult services must be better equipped to recognise and respond to substance use, and have stronger referral pathways in place.

The report also highlights the importance of landlords and housing agencies completing health and well-being checks which could include alcohol screening, and referring  to specialist agencies as appropriate. From our assessment data of Drink Wise, Age Well service users in Wales we identified that 49% are separated, divorced or widowed,  51% live on their own and  64% typically drink at home alone. Older adults who are drinking at high risk levels can be very hidden and in our 2015 Drink Wise, Age Well Report we found that 4 out of 5 increasing risk drinkers had never been asked about their drinking by family, friends or health professionals. Often housing professionals and landlords are the only point of contact and it is vital that they are equipped with the skills and confidence to broach the subject, and respond appropriately. In Cwm Taf Drink Wise, Age Well delivers training to front line staff and to date 83% of attendees report increased knowledge of age-specific issues, and over 72% state they intend to make changes to their practice as a result of attending training.

New approaches to service delivery

Finally the report recommends new approaches to service delivery which includes resilience interventions to support older adults with difficult life transitions. In Cwm Taf as part of our integrated programme, we provide resilience interventions in the community. This includes a six week programme using cognitive behavioural and behaviour activation approaches along with volunteering and befriending opportunities to help build up resilience, well-being and avoid using alcohol as a coping strategy.

The APoSM report is hugely welcomed at a time when resources in social care are increasingly sparse.  To see ministerial support for the recommendations in Wales would demonstrate a firm commitment to an ageing population with substance misuse issues, who too often fall beneath the radar. Older adults can and do respond positively to treatment and support, often more than any other age group so it’s time we gave them the chance to do so.