Drugs, ageing and homelessness in Australia. Lucy Burns National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia

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1 Drugs, ageing and homelessness in Australia Lucy Burns National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia

2 Structure Evolution of the baby-boomer generation What this means for drug use and ageing in Australia Housing issues What does this mean for policy and practice?

3 Alcohol use and problems are not new. "...alcohol has existed longer than all human memory. It has outlived generations, nations, epochs and ages. It is a part of us. For most of us it will continue to be the servant of man (and woman) but will always be the master of some." Our recent history Morris Chaftez, Founding director, National Institute on Alcohol Abuse and Alcoholism. OUR RECENT HISTORY

4 Birth of the baby boomers: End of WW2 in 1945 Australia's ex-service men and women returned to family life after 6 years of war conflict Came back with legacy: use of substances during Methamphetamine/ uppers to work, alcohol to wind down Nine months after return childbirth rates soared more than 4 million born : baby boomer generation Increased migration to Australia through negotiated agreements with other governments and international organisations e.g a system of free or assisted passages for United Kingdom residents

5 1950s and 1960s: Teenagers and young adults Increased advances in science and technology Widespread testing and use of new synthetic pharmaceuticals Big Pharma LSD testing, wider use of new drugs in psychiatry experimentation with mind altering substances Prescription drugs and painkillers readily available Cultural change: new and different music: rock and roll 1960s: bands, fashion Vietnam war: use of cannabis by troops and anti-war protestors

6 1970s and 80s Between population leapt by 3 million Drug experimentation continued: cannabis, LSD, heroin Vietnam war: anti-war protestors rebellion against authority Labor came to power Gough Whitlam Free university education, Withdrawal of Australian troops from Vietnam Anti-discrimination laws for Aboriginal people Economic prosperity good health care Increased longevity

7 Now and the future: Baby boomers 60+ Outcomes of problematic substance used different in older; Heighted sensitivity and reduced tolerance - same level of alcohol will have an increased effect Physiological changes (smaller body volume/mass) = increased impact Leads to accelerated ageing: impaired stem cell regeneration and increased rates of cell death When 40: biological age of 60 Heightened use of medications that interact with alcohol, such as sedatives and tranquillisers Poor mental and physical health Women s use converging with men s: roles changed dramatically: moved into workforce leisure pursuits that were traditionally male dominated eg. Pubs; work social activities. Increased alcohol use Telescoping of outcomes women become sicker quicker

8 What are the contemporary drug patterns in older Australians

9 Daily alcohol use by age: Male Female More daily use Less amount but more effect

10 Places of alcohol consumption Home Friends house Licensed premises Restaurants Parties Increasing consumption at home Increasing social isolation Medication interaction/ Increased falls

11 number per 1,000 population Oxycodone prescriptions per thousand population, by 10 year age group,2002 to / / / / / /08 20 to to to to to to Most by older groups Increasing over time Interaction with other drugs/ alcohol

12 Overall number of adults aged 50 or older with substance use disorder projected to double by 2020 INCREASED SUBSTANCE USE = INCREASED LIKELIHOOD OF LOSS OF HOUSING

13 Who are homeless in Australia? 100,000 Australians homeless each night, sleeping in different places Most staying with friends/relatives Half are under 24 and 10,000 are children Increasing number of older people homeless (18% 2006 Census Counting the Homeless) Homeless Census , , ,000 80,000 60,000 47,000 40,000 20,000 16,000 20,000 21,600 0 total rough sleepers/improvised dwellings (primary) SAAP accommodation (secondary) staying with friends/relatives (secondary) boarding houses (secondary/tertiary)

14 Linking substance use and homelessness in older Australians

15 Homelessness among older Australians Both structural and individual factors (1) Individual : as noted poor physical / mental health; (2) Also structural: Lack of acceptable / appropriate housing 2 groups : first time homeless at older age and chronic homeless First time homeless more likely to be women homeless in response to housing market/ policies; welfare safely net Long-term homeless more likely to be men poor physical/mental health

16 Structural factors related to homelessness There is a great divide in Australia between those older people who have secure and stable housing and those who live precariously in private rental accommodation that is unsafe, expensive and insecure. Private: Chronic undersupply and high cost Not age-appropriate: Unwillingness of many landlords to modify houses in line with support needs, housing poorly suited to needs of older peole. Social: Limited amount of age appropriate social housing Aged care: Residential care required for some BUT Mainstream services ill equipped Premature ageing 54 to 50 and over Special care needs around ARB

17 Requirements Greater awareness of housing issues amongst health and aged care services, expansion of housing advice and support services to assist older people in housing crisis and greater provision of affordable housing. Take account of substance related health issues leading to increases in Mental health : increased mood and anxiety disorders, psychoses and alcohol related cognitive disorders, increasing social exclusion: sever links with family and non-drug using friends, death of partner Physical health: increased chronic disease, infection, poor dental care,, lung cancer bronchitis (smoking), falls, liver cirrhosis, dementia, End stages of long standing BBVs HIV, Hep C, Hep B

18 Other requirements Housing that accommodates any disabilities, does not require extensive maintenance and located close to amenities and public transport. Located in familiar neighbourhoods. Home based care with integrated services allows for ageing in place Successful housing associated with previous stable accommodation history, revived contacts with family, taking up activities, regular help from housing support workers Gold standard services EXIST eg Wintringham

19 The special case of older women Homelessness in older women increasing; Not previously homeless Previously worked, raised children time off work At risk of homelessness through health crisis / age discrimination at work BUT will be poorer than men their age, less able to maintain home ownership and less able to compete in the private rental market Low income/ lack of savings, lack of equity in housing Not in need of residential care require affordable, safe housing

20 Alcohol Related Brian Injury Brain organ most sensitive to the toxic effects of drugs and alcohol High number of brain injuries from falls and assaults and injuries Wernickes encephalopathy: Direct result of alcohol use: thiamine deficiency Persistent learning and memory problems. Forgetful and quickly frustrated and have difficulty with walking and coordination. Korsakoffs psychosis: problems remembering old information but cant process new information For example, these people can discuss in detail an event in their lives, but an hour later might not remember ever having the conversation.

21 Brain injury: Sample of 50 homeless people % who experienced each type of ABI mean number of incidents among those who experienced each ABI Traumatic brain injury (TBI) Hypoxic events Alcohol related brain injury (ARBI) Infectious processes Prevalence of any acquired brain injury (ABI) 88% Cognitive assessment similar scores to people with Alzheimer's Disease Extremely high levels of psychological distress

22 Ageing of people in drug treatment All treatment episodes , 8, or over , 19, or over; 54.2% alcohol, 34.3% opioids Methadone treatment % 40 and over % 40 and over Ageist policies: Despite ageing of population policies still focussed on prevention and youth Need to rethink drug use as firmly linked to youth behaviour alone

23 Chronic physical conditions among younger and older participants Ever diagnosed (%) Younger IDU <36 years n=435 Older IDU 37+ years n=440 Asthma 33 26** Cancer 6 6 Stroke 2 3 Heart/ circulatory conditions Gout/ rheumatism/ arthritis 7 15* Diabetes 2 4 Increases in chronic disease

24 SUMMARY Care of older people previously viewed in medical model and placement in old folks home Divorced from society Funding moved from prevention to crisis care But wellbeing flows largely from sense of home and quality of community life Older people rendered powerless, social exclusion, lack of respect and alienation Increased social housing but often not appropriate Many people in hostels/ nursing homes for accommodation not health Would prefer to be in their own homes Home increases wellbeing particularly for older people

25 SUMMARY Expect more older Australians who are homeless and alcohol dependent Homelessness related to : retirement; loss of income, loss of significant others (spouse/partner/children) First time homeless AND Poor mental health : mood and anxiety disorders, psychoses and cognitive disorders chronic homeless

26 Conclusions Irrespective of presence of brain injury or anti-social behaviour these individuals are entitled to receive care and support that is both appropriate to their needs and which promotes empowerment and independence Housing should meet the needs and requirement of this group BUT Lack of affordable housing appropriate to needs of older with substance use disorders Lack of sufficient income to maintain an adequate standard of living WHO PICKS UP THE TAB??

27 Individuals who are most marginalised will carry the burden Further details: Lucy Burns THANK YOU

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