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Research

Developing nursing practice, treatment and support services for ageing drug users

  • Comment

Substance misusers who started taking drugs as part of the 1960s ‘hippy culture’ are now part of the growing population of older drug users

Author

Brenda Roe, PhD, RN, RHV, FRSPH,is professor of health research, evidence-based practice research centre, Edge Hill University and is an honorary fellow, personal social services research unit, University of Manchester.

Abstract

Roe B (2010) Developing nursing practice, treatment and support services for ageing drug users, Nursing Times, 106: 45, early online publication.

Background Ageing drug users are a growing population who are have problems accessing services and support.

Aim To inform practice, service development and further research on ageing drug users.

Method Qualitative interviews with 11 people aged between 49 to 61 years who were in contact with voluntary sector drug treatment services.

Results Individuals reported mixed experiences of primary and hospital care, with some feeling stigmatised by health care professionals while others said they received acknowledgement of their drug use and compassion.

Discussion and conclusion Nurses and other care professionals working with older people should be sensitive to the needs of this small, but emerging population and tailor care and services to their needs. 

Keywords Drug users, Vulnerable population, Addiction

  • This article has been double-blind peer reviewed

 

Practice points

  • Use of illicit drugs by older people does not feature in policy or service provision.
  • This research shows a variety of drugs are used by older people.
  • Ageing drug users are a vulnerable population, with impaired health status, health needs, chronic conditions and poor quality of life due to their addictions and life experiences.
  • Drug treatment services for older people are not widely available.
  • Nurses and other care professionals working with older people should be sensitive to the needs of this small but emerging population, and tailor care and services to their particular needs. 
  • Older people who have used drugs, or who continue to substance misuse, can play an important role in health education programmes designed to deter younger people from using drugs. 

 

Introduction

In a recently published study, Roe et al (2010) highlighted the issues faced by ageing drug users- an emerging population involved in problematic or illegal and recreational drugs use. These individuals experience a variety of acute and chronic health conditions, which results in impaired health and quality of life. They are a particularly vulnerable patient group as services for older drug users are not widely available, and yet many require continuing care.

Although a relatively under-researched group, their continuing drug use, addictions and accelerated life experiences make them a small but important population that nurses and other care professionals need to be aware of and be sensitive to their particular needs. This study provides preliminary insights into the unique experiences of ageing drug users that can be used to inform practice, service development and further research.

Background

Researchers predict the number of people aged 50 years and over with drug or alcohol problems requiring treatment is set to increase. Projections from the USA estimate a rise from 1.7 million people to 4.4.million between 2000 and 2020 (Gfroerer et al, 2003). In Europe it is estimated that the number of people aged 65 years and above who need treatment will double between 2001 and 2020 (European Monitoring Centre for Drugs and Drug Addiction, 2008).

A study in the North West of England of data from drug treatment services and agency-based syringe exchange programmes reported a significant rise between 1998 and 2005 of both male and female users aged 55 to 59 years and men aged 60 to 64 years. During that period, the number of men using drugs increased from 1.5% to 3.6% and the number of women involved in substance misuse grew from 1.9% to 3.2% (Beynon et al, 2007). In the UK problematic drug use has been defined as use of opiates or crack cocaine (Home Office, 2008).

Services for older people who misuse drugs in the UK are not widely available or accessed (Crome and Bloor, 2005a; 2005b; 2006) and often drug and substance misuse among older people goes unnoticed and access to services or treatment is not provided.

It was a direct result of our research team’s experience of caring for ageing drug users receiving treatment in primary care, and in and out-patient care, that led to an earlier study (Beynon et al, 2007). We then went on to investigate older people’s experiences of drug use and ageing and how it impacts on health, quality of life, relationships and service use (Roe et al, 2010). Our aim was to inform current practice, the development and commissioning of services and future research. This research is particularly relevant for ageing populations in developed countries who are living longer, who may have long term conditions and require health and social care services.

Study findings          

The study involved qualitative interviews with 11 people aged between 49 to 61 years (nine men and two women with a mean age of 57 years) who were in contact with voluntary sector drug treatment services.  All were single, with five having been previously married but then divorced, and eight were living alone. The remainder either lived with another male who acted as a carer, next door to a male carer or with other drug using friends.

Their homes ranged from social housing, a hostel, caravan or care home.

Most of them started taking drugs as adolescents or young adults for recreational use, to experiment or because it was part of the culture of the 1960s “hippy” era. Child abuse and/or death of a parent were also cited as early life triggers for drug taking. However, there were some who started using drugs in their 40s in response to stressful life events such as divorce or death, or because of another drug using partner. Their first drug use included magic mushrooms, LSD, amphetamines, cannabis and heroin. No single drug acted as a gateway to others. Alcohol use and smoking also featured alongside their drug use.

Over time, some of these individuals increased their drug use while others had periods where they tried to reduce or abstain from drugs. Substance misuse was often associated with chaotic lifestyles and relationship breakdowns, divorce and loss of access to their children, which contributed to feelings of loss or sorrow.

Many of them had accelerated life experiences of death and dying. They described the premature deaths of friends, family members and other drug users due to overdose or accidents, as well as their own experiences of having overdosed or accidents.

Some reported periods of imprisonment, which they said had actually helped them to survive because it meant they had repeated periods of abstaining from drugs. Nine participants were taking methadone as maintenance or as part of a reduction strategy with a view to abstaining from drugs.

Some participants did have access to their families and had been able to sustain important relationships. This was particularly the case where they had ceased using particular drugs or were abstaining from drug use.

Pets were also important for some individuals and they provided companionship, a sense of responsibility as well as structure to their day.

Most of the people taking part in the study recognised their drug use was having detrimental and cumulative effects on their health, and they had developed chronic or life threatening conditions, which required hospitalisation and continuing treatment. Their physical health conditions included:

  • Circulatory problems - notably deep vein thrombosis or injection site ulcers;
  • Stroke;
  • Respiratory problems such as pneumonia;
  • Hepatitis;
  • Liver cirrhosis;
  • Diabetes.

Common mental health problems included memory loss, changed mood states, anxiety, anger and paranoia. Malnutrition, weight loss and obesity were also features, as were accidental injuries due to falls or drug overdoses.

All participants wished they had not started using drugs and would advise young people not to do so. A few were keen to give up completely but others felt it was just too hard. One man described drug use as “disgusting and squalid”. Another stated: “The more I seem to get older, the more it seems to go worse. At 56 now, I shouldn’t be doing this. I shouldn’t be going out grafting and then running round like a 19 year-old ‘scally’ looking for heroin and coke. Like I shouldn’t be on methadone now. It’s madness.” 

However, a number of individuals were trying to use drugs responsibly and their age and influence of drug treatment services were factors in this. As a result of previous experiences they also seemed more aware of a need to maintain their personal safety. They were positive about the support they received from the voluntary drug treatment services, which included drug treatment and bereavement counselling. However, some felt these services could be more sensitive to the needs of older drug users, particularly in relation to group work where they felt they had little in common with younger drug users. Some preferred individualised approaches for this reason. They reported mixed experiences of primary and hospital care, and a few felt stigmatised by health care professionals while others said they received acknowledgement of their drug use and compassion.

This study interviewed a small sample recruited from the voluntary sector. To provide a greater understanding of the issues faced by ageing drug users a larger representative cohort followed up over time is required. This should include people who were more affluent and who may pay for drug treatment services, as well as those people who were not receiving services

Conclusion

The use of problematic or illicit drugs by older people has not featured in policy, research or service provision, which has been restricted to younger populations. However, our research shows a variety of drugs have been, and continue to be used by older people. Ageing drug users are a vulnerable population, with impaired health status, health needs, chronic conditions and poorer quality of life due to their addictions and life experiences. Although they are in need of care from health, social and voluntary sectors, drug treatment services for older people are not widely available.

Nurses and other care professionals working with older people should be mindful and sensitive to the needs of this small but emerging population, and tailor care and services to their particular requirements.  Awareness of these issues should be raised so that services can be commissioned and developed to meet the demands of this group, particularly given that it is imperative they are able to access services.

Older people who have used drugs, or who continue to substance misuse, can also play an important role in drug prevention and can participate in health education programmes designed to deter younger people from using drugs. 

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