Analysis

'Silent impact' of the baby-boomer generation's substance misuse

The long-term effects of a cultural shift that saw recreational drug and alcohol use rise are now surfacing

The long-term effects of a cultural shift that saw recreational drug and alcohol use rise are now surfacing


Baby boomers grew up when recreational drug use, particularly among women, became normalised. Picture: iStock

Substance misuse among older people is growing and non-specialist health professionals, including nurses, need to recognise the problem as their business too, according to a report.

Our Invisible Addicts, published by the Royal College of Psychiatrists (RCPsych), follows a 2011 study that found the proportion of older people with substance misuse problems continues to rise more rapidly than can be explained by the increase in the proportion of older people in the UK.

However, the baby-boomer population, now aged between 53 and 71, is at the highest risk of substance misuse. Unlike previous older generations, baby boomers grew up during decades when recreational drug use and higher levels of social drinking, particularly among women, became normalised and this population may not recognise their misuse problems.

The long-term health and psychological effects of this social shift are surfacing now that baby boomers are reaching older age, explains Gill Campbell, lead nurse for substance misuse charity Turning Point.

‘Someone who has always drunk heavily or taken cocaine, who thought they were able to manage their habits, will have had silent impacts on their health but may not recognise the harm as they get older,’ she says.

Baby boomers

People aged between 53 and 71 are at greatest risk of substance misuse

(Source: Royal College of Psychiatrists)

'Addictions stay with people'

RCN professional lead for older people and dementia care Dawne Garrett agrees that the trend is likely to continue. ‘Addictions stay with people and someone who has always used a lot of cannabis is probably going to use it more as they get older for pain or anxiety,’ she says.

Ms Garrett says alcohol has always been an ‘extremely large and often unrecognised issue’ for older people. ‘So many people suffer from loneliness and social marginalisation, and alcohol is highly available.’

The RCPsych report also highlights that misuse of prescription painkillers such as morphine and buprenorphine, as well as gabapentinoid drugs, is a growing public health problem.

Some of the harmful effects of long-term alcohol and drug misuse include alcohol-related dementia; liver damage; respiratory conditions, such as chronic obstructive pulmonary disease; and mental health problems. Death rates in older people with substance misuse problems are higher than the general older population, and deaths in older people related to poisoning from substances have more than doubled over the past decade, the study found.

While this problem has been growing, ‘fewer nurses are employed in alcohol and drug worker roles than ten years ago’, according to a report on nurses in alcohol and drug treatment services published by Public Health England and the RCN last September.

66

Average age of people prescribed benzodiazepines

(Source: Royal College of Psychiatrists)

Fewer nurse specialists

Nurse consultant for dual diagnosis at South London and Maudsley NHS Foundation Trust Cheryl Kipping, who advised the RCPsych’s working group, explains that the shift from providing drug and alcohol treatment services in the NHS to the voluntary sector has resulted in fewer nurses working in these services.

Often, they will be provided more cheaply, with fewer specialists and less able to work with people who have more complex needs.

‘The limited resources available to specialist substance misuse services make it difficult for them to be flexible and respond to people’s individual needs, resulting in access to genuinely person-centred care being patchy,’ Dr Kipping says.

Our Invisible Addicts highlights the need to improve access and availability to specialist services and calls for a government-supported national strategy outlining cohesive integrated policies, implemented at local, regional and national levels.

Ms Campbell says Turning Point already offers flexible services in partnership with health and social care organisations.

Hospital liaison workers

30%

Percentage of hospital admissions in England related primarily to alcohol in people aged 65 and over between 2016-2017

(Source: Royal College of Psychiatrists)

For example, the charity provides hospital liaison workers who assess people who have had slips, trips and falls and may be at risk of substance misuse.

‘We are also trying to see people in community areas, such as health centres and libraries,’ she explains. ‘The challenge is to get older people to recognise that we can offer them something to meet their needs and in an environment that suits them.’  

She believes that specialist nurses can add value to supporting and treating older people with substance misuse, ‘because we can work with the other problems that come with the added complexity of ageing’.

Nevertheless, Dr Kipping believes the take-home message for nurses and everyone working with older people is to see identifying these problems as part of their remit.

‘Historically, substance misuse was thought of as a specialist area and you can’t think about it like that anymore. It’s everyone’s business,’ she says.

'Significant impact'

‘Whether you are working in health or social care you need to know if people are drinking and taking drugs as well. We know that substances have a significant impact on physical and psychological health and we know that problematic use often goes undetected because people haven’t been asked.’

The level of awareness of substance misuse problems among non-specialist nurses is generally low, says Dr Kipping.

‘Uncertainty over what to do if they uncover someone who’s got a problem may hold nurses back,’ she says, adding: ‘I’m always shocked that people are still coming into the profession with very little input at undergraduate level on substance misuse.’

The lack of education on this issue was flagged up in a 1996 report from the English National Board for Nursing, Midwifery and Health Visiting. ‘Over 20 years later I don’t think we’re that much further forward,’ Dr Kipping concludes.

The RCPsych report reiterates this in its recommendations, stating that ‘education and training at all levels are central to addressing the challenges posed’.

'Sherry at mealtimes'

Nursing and support staff working in care homes may have even less access to training.

Ms Garrett says while drug misuse may be easier to control in these environments, access to alcohol can be a problem. ‘In many care homes it’s not unusual for people to have a sherry at mealtimes, some even have bars.

'It’s important that staff understand the issues,' she says.

‘It’s about unpicking why someone might be reliant on alcohol. Older people have higher levels of loss – loved ones, independence, financial – they have more triggers that can lead to substance misuse.'

Substance misuse in older people: what can nurses do?

  • Screen all older people for alcohol and tobacco misuse
  • Ask older people about other substance use and misuse
  • Be alert to signs of drink and drug misuse, such as lots of empty bottles during a home visit
  • Be supportive, non-judgemental and non-confrontational, flexible, sensitive to gender and cultural differences, focused on client functioning, coping and social skills, and holistic
  • Get training in how to recognise and advise on substance misuse through brief interventions. e-Learning for Healthcare and Health Education England offer resources – Alcohol Identification and Brief Advice
  • Find out about available specialist services
  • Behaviour change management techniques commonly used by nurses in the care of patients with long-term conditions are transferable to supporting patients with substance misuse 
  • Liaise with practitioners and agencies, as well as family and carers

(Source: Royal College of Psychiatrists)

Dos and don’ts of clinical interactions from a patient’s perspective

  • Listen to what the person has to say. Make them feel they are important, what they say is important and that they are being heard
  • Use your skills to sum up your patient. All patients need handling differently and some can take, or may need, a tougher line than others
  • Help the person to restore their self-image. Point out what they have to offer
  • Remain professional however emotional the case may make you feel, but also remain human and approachable
  • Remember how vulnerable your patient is. Their outward show of strength, or aggression even, may hide what’s inside
  • Remember that however many meetings you may have, whatever time of day it is, this one is the patient’s special appointment and is hugely important to them. They have probably been psyching themselves up for this meeting with you
  • Never try to force a patient to do what they don’t want to do – it will end in tears and you’ll be back at square one

(Source: Royal College of Psychiatrists)

 

Further information

Royal College of Psychiatrists: Our Invisible Addicts

Public Health England and RCN: The Role of Nurses in Alcohol and Drug Treatment Services 


Louise Hunt is a freelance writer

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