Seniors are one of the fastest growing population groups in Canada. In 2000, there were an estimated 3.8 million Canadians aged 65 and older (1 in 8 Canadians), up 62% from 2.4 million in 1981. Fifty-seven percent of seniors are women; in 2000, 70% of those 85 and older were women. The rapid growth of this population is expected to continue well into the future, as baby boomers (those born between 1946 and 1966) reach this age in coming decades. It is projected that by 2021, there will be almost 7 million Canadian seniors, representing 19% of the population.
Alcohol is the most commonly used psychoactive substance among today's seniors aged 65 years and older. Although their level of alcohol and tobacco use is lower than in younger age groups, their prescription drug use is higher, particularly among women. Canada's Alcohol and Other Drugs Survey (1994) reports that use of prescribed tranquillizers, sleeping pills and antidepressants by Canadians increases with age, with 27.4% of those 65 or over using one or more medications. This may arise from the perceived acceptability of using these drugs at an age when women may be reducing their alcohol use because of social controls and perceptions of appropriateness. As the baby boom ages, the number of people experiencing problems with illicit drugs may also increase. Closely associated with substance use issues are high rates of depression and suicide among seniors. Many elderly people are isolated, having lost a spouse, or having experienced financial problems or abuse from family members. In addition to substance abuse and mental health problems, seniors may experience many difficulties in daily living, such as home skills, self-care, transportation and shopping. They tend to be reluctant to admit to having a mental health or substance use problem, and seldom ask for help. Problems with prescription drugs may be overlooked because such drugs are prescribed and seen as legitimate, and over-the-counter medications may not be seen as drugs at all. The social isolation of many older adults makes it less likely that those experiencing problems with substances will be identified by those around them.
Moreover, seniors with substance use issues are often not readily identified by professionals with whom they come in contact; signs of a substance use problem are often attributed to the effects of aging. Such signs may include memory problems, confusion, a lack of self-care, depression, sleep problems, and falls. Alcohol and drug problems in this population are commonly accompanied by multiple or severe medical problems, either caused or aggravated by the substance use. However, health professionals may be reluctant to confront an older person about his/her drinking or drug use, believing that it is "too late" for the person to change.
Older adults are likely to experience problems at much lower levels of drug consumption because of changes in kidney and liver functions, physical health problems that are related to aging, and because of the interaction of medications (including central nervous system depressants) with alcohol.
Several sub-groups of seniors with alcohol problems have been identified, including those who have a long-term history of problem drinking, as opposed to "late onset" problem drinkers who typically start drinking in response to a serious life event. Early-onset clients often have serious physical complications, and tend to have a poorer prognosis than late-onset problem drinkers. Clients experiencing problems with prescribed or over-the-counter medications, alone or in combination with alcohol use, comprise other sub-groups.
For a variety of reasons, traditional addiction treatment programs may not be suitable for older persons (for example, the issues addressed in traditional programs may not be relevant to the lives of older persons, and the pace of the program may be too fast or difficult to follow because of hearing or vision impairment). Consequently, flexible, individualized community-based treatment provided through services that support health and the activities of daily living is considered to be more effective. Substance abuse programs for seniors may also need to consider close links with mental health agencies to address the needs of seniors experiencing co-occurring mental health problems such as depression.SourcesBest practices: substance abuse treatment and rehabilitation
Ogborne, Alan; Roberts, Gary
Ottawa, ON: Minister of Public Works and Government Services Canada, 1999.Canada's seniors
Ottawa, ON: Health Canada, [1999-].Older adults
Substance Abuse Network of Ontario
Toronto, ON: Centre for Addiction and Mental Health, [1999-].