Psychedelics After 65
More people over 65 are using psychedelics than ever before. For grief. For depression. For pain. For fear.
The research has barely looked at them. Across 36 trials since 1967, only 19 participants were 65 or older.
So the real questions get asked in the dark. Is it safe with his blood pressure meds? What about her balance? Is 78 too old? Is hospice too late?
Let's get into it. Not to be morbid. Turns out this is mostly a conversation about living well.
What we'll cover
What actually changes in the body after 65, and what that means for safety
Which substances carry which risks, plus the screening questions most people never think to ask
How psychedelics support people in later life, not only at the end of it
What the research shows about fear of death, hospice, and dying well
How to talk to someone you love about any of this
Who this is for
People in their later years who are curious. Guides, sitters, and integration practitioners working with older clients. Hospice and palliative care workers. And anyone with a parent, partner, or friend they've been quietly worried about.
No experience with psychedelics required. Nothing here assumes you've ever taken anything.
Psychedelics After 65
Safety, Benefits, and the Fear of Dying
This transcript has been lightly edited for readability. Filler words and false starts have been removed; the substance is unchanged. Educational content only, not medical advice.
The dancer
What inspired me to do this talk is that I go dancing about once or twice a week here in New York City. There's a man in the community who's 82, and I often think he dances better than most people there. He's joyous, he's flexible, he's energetic. It's so great to have him there.
Nobody after dance is talking about the topic of death or dying. And we're all doing it anyway.
The gap
When it comes to psychedelics, there is a gap. The people most likely to be facing death, serious illness, and cumulative grief are the people the psychedelic field has studied the least.
Of the 36 trials done since 1967, out of roughly 1,400 participants, 19 were over the age of 65.
Everything I'm about to tell you regarding safety is extrapolated from data collected mostly on people in their 30s and 40s. That's not a reason to avoid psychedelics. It's a reason to be careful, and to be honest that we don't know much about this generation compared to others.
What this is and isn't
This is educational, not medical advice. It is not a recommendation to use anything illegal. I'm a guide, not a doctor.
About me
I'm Josh Jupiter. I founded Brooklyn Balance in 2022, and I work full time as a psychedelic integration coach and facilitator. My background is in training with MAPS and TAM Integration, direct client work, and various communities.
When it comes to death and mortality: I was in a serious car accident at the age of 24, and it shaped the way I view life and how I live it today.
Who's in the room
There may be people here in their later years. A lot of people who registered are guides, sitters, and integration practitioners. Some work in hospice or palliative care. And of course there are people who love someone later in their life.
Where we're going
We'll talk about what changes after age 65, what to watch for, why this helps later in life, the fear itself, and what happens at the very end.
There will be a short exercise later, so if you have pen and paper handy, that would be great. You don't have to do it. It's totally your choice.
What actually changes
As we get older, a few things shift: blood pressure regulation, medication load, balance and gait, physiological reserve, and sensory processing.
The body metabolizes stress and all things differently at 75 than at 35. That's a fact to plan around, not a verdict on anybody.
The medication reality
For older adults hospitalized with cardiovascular disease, 95% or more are on five medications or more. The average was over 11 medications. And over 77% had at least one severe potential interaction.
The point isn't that psychedelics are dangerous when mixed with medications. The point is that we want to be safe. Is this safe for somebody over 75 who's on 11 different medications? Is this safe for somebody with cardiovascular disease?
In underground work, this step often gets overlooked. Discovering a medication late in a screening conversation can lead to consequences. We want to be more mindful and more cautious as people get older.
Blood pressure, the actual numbers
This chart shows how blood pressure changes over time after a dose of psilocybin. At around an hour, systolic pressure has gone up almost 20 points. Diastolic is up about 9. Then things mellow out over time.
It's this rise that can pose risk to people over 65. For someone in their forties, it's unremarkable and transient. For someone with poorly controlled hypertension or a cardiac history, this is one of the most important numbers in the talk.
Note that the trial participants these numbers came from were all medically screened and intensively monitored, which almost nobody outside a trial is. Should somebody take a blood pressure reading beforehand rather than guessing? It can be important.
The part nobody says
We hold psychedelics to a standard we have never held things like Ativan, or trazodone, or Ambien.
The truth is that both deserve scrutiny. Some psychedelics may carry lower risk than a prescription medication, and the reverse is also true. The risk of falls, sedation, and cognitive impairment comes with both.
What to actually worry about
The heart. Blood pressure goes up and stays up for an hour or two.
The fall. Balance shifts, and it can last for hours.
The medicine cabinet. What's already in there, including supplements and prescriptions.
The clock. Four hours and twelve hours are different asks of a body.
The mind. Where's the baseline, and is something already changing?
How they compare
Psilocybin lasts 4 to 8 hours. The risks are heart and falls. Someone might lose balance.
MDMA is the heart again, plus hydration and overheating.
LSD is a really long experience, 8 to 12 hours. For an older body, the clock is something to really consider.
Ketamine is shorter, but there are falls, blood pressure, and dissociation. And a big question of who's supervising, because we've seen a lot of telehealth ketamine. People are mailed ketamine, they're prescribed ketamine, they go home, they lie on their couch, they take it. Often no one's there but them.
Ayahuasca carries some of the more serious ones: MAOI interactions, purging, blood pressure, and risk of dehydration.
5-MeO-DMT is on the shorter end. There can be loss of motor control, MAOI interactions, and antidepressant interactions.
Something to consider is that dose changes the picture. 5-MeO at a lower dose can be gentler, more meditative. And even at a higher dose, there's less worry about how many times someone will need the bathroom during the experience. But it can be really physically demanding. 5-MeO is also vaped, which can put stress on the lungs.
Microdosing
It's very common today to hear about microdosing, and it's common for people over 65 to consider it. Some things to know:
You're taking it alongside everything else, every week, for months.
Most people are not telling their doctor that they're microdosing.
You might not know the dose. Mushroom potency varies a lot by strain and batch. Someone might get chocolate mushrooms where one square says 0.1 grams, but we don't actually know.
Spacing can matter more than size.
This is not a reason not to do it. It's worth knowing before building a routine around it.
The questions few ask
People in this space might not ask for a full medication list, including supplements. They might not ask:
When was your last cardiac workup?
Have you had any falls in the past year?
What's the cognitive baseline, honestly?
Can this body sit for six hours or more?
Who's there for the next three days?
Will this person be by themselves? If they need extra support, who will actually be with them?
Not just about dying
Most of this isn't about death at all.
What I personally see when people over 65 come to me is grief that's stacked up. Depression that arrived after retirement. Someone who might not feel they have a purpose, who might feel lost. People who feel isolated. A life that got really narrow.
What's emerging
As we age, the immune system settles into a kind of low-grade inflammation that never really switches off. Researchers call it inflammaging. It shows up in depression, in Alzheimer's, in Parkinson's. One of the reasons depression in later life can be stubborn is that it may not be purely psychological.
Separately, there's a protein called BDNF. Think of it as fertilizer for brain cells. It drops as we age, and it drops in depression. Psilocybin appears to turn that pathway up. In animal studies, you can actually see new connections forming between neurons.
And the same receptor psilocybin acts on also sits on immune cells, which raises the possibility that one compound touches both the inflammation and the mood.
It's important to mention that almost all of this is cells in a dish, or a rodent in a lab. No human trial has shown that psilocybin reduces inflammation or slows a neurodegenerative disease just yet.
I personally find it very exciting, because there's a lot of research going on. And I don't want to oversell it. It's not a silver bullet.
The narrowing
Later in life there can be a bit of a narrowing. Nobody chooses a small life. It accumulates.
Every "no, I'm not going to do that" was reasonable. This is just how my knee is. I don't want to drive at night. I don't want to go up the stairs. Money. Potential embarrassment.
Nobody decides to just stop going out. It happens slowly over time, through sensible decisions that build up and accumulate.
What older participants report
Reconnection. Reconciliation. Permission. Allowing themselves to do things they've quietly been forbidding themselves for years, maybe decades.
What they actually say
What are people actually saying when they show up? Rarely is it "I'm afraid of being dead."
Usually what's behind it is fear of losing control of my body. Fear of losing control of my life, my autonomy. Fear of not being remembered.
The exercise
Adapted from Mary Cosimano's Personal Death Awareness exercise.
If it feels good to you, we'll do a little practice. You can opt out. If you're at work or driving and listening in, you can do it later, or not.
Draw a line that represents your whole life. Beginning of your life to end of life.
Mark where you are now.
Fill in the blank: I expect to live until age ___
How does it feel to commit to a number?
And now just notice.
John D: No one had ever asked that question. I'm 77 now, and I put 85. The reaction to that felt liberating. And stimulating. The thought is: hold on, the things I want to do, I better get going on.
Nancy R: I've thought about this before, but I hadn't done it today. Drawing the line, I was fine with that date. I felt a little bit like John said, kind of liberating. It didn't feel scary. But then I'm not that age yet, so I don't know.
What control cost me
I called it being careful. It was mostly being afraid.
After I was in a serious car accident at 24, I stopped doing a lot of the things I enjoyed. I was way more cautious. I said no to a lot of invitations.
I realized some years later that it cost me a lot of experiences. It cost me a lot of joy. It cost me a lot of really great memories and positive experiences.
So I don't want fear to dictate my decisions, or influence them too much. And at the same time there's a balance, because there is a reality to things. That accident really did largely shape how I walk and approach things in the world.
It's about doing the things I want to do, because time is ticking either way. And it's about feeling into what's behind the fear. One of the things psychedelics have been really beneficial for me with is getting attuned to what the fear is, and releasing it.
Intention
"What you share is not as important as why you share it." Gary Zukav, quoted in Mary Cosimano's The Role of the Guide in Psychedelic Assisted Therapies
This brings me to the question of intention, whether it's psychedelic work or non-psychedelic work, whether someone is working hospice or is a nurse doing her day-to-day duties.
Ego versus love. Sharing to look smart, or wealthy, or generous. Acting from a place of fear or pride, versus sharing to genuinely help or connect, coming from love and trust.
It's the energy behind the action. Two people might do the same exact physical act. One might seek applause or control, while the other offers pure support with no strings attached. One builds real bonds and authentic healing. The other creates invisible debts and resentment.
So it's feeling into the intention of our time: what we have to offer, what we want to do, and how we want to make memories and share experiences.
What we know
There are three studies I've cited here: Grob, Roland Griffiths, and Steven Ross. Each one gives really good insight into the benefits of psychedelics later in life, and in general for treating anxiety and depression.
Griffiths' psilocybin study in particular produced substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer, in a randomized double-blind trial. There's a sources page at the end of this talk.
The durability
In these studies, 60 to 80% of people were still responding positively after six and a half months. Some showed significant improvements still holding at four and a half years.
One story
One of the people I worked with came to me later in life. Divorced. Depressed. They'd been in recovery for a long time but struggled with treatment-resistant depression, and had been on some form of antidepressant or mood stabilizer for the past 20 years.
They sat with a moderate dose of psilocybin. A few days after, they reported significant relief with their depression, and felt they didn't have to go back on their SSRI.
That was about four years ago. To this day, I know that this person is not on their antidepressant, and that they've been living their life more meaningfully and joyfully, moving forward with their purpose to be in service and to help those around them.
What's actually available
If someone is considering working with a psychedelic: there are clinical trials. Many people are traveling to Oregon or Colorado. There's ketamine, by prescription and telehealth. There's Right to Try. And there's the underground.
I'll also mention that yesterday was the day the FDA closed public commenting on the future of psychedelics. So we may be seeing some new avenues in the near future.
If someone came to mind
If you've been listening to this talk and thinking about a specific person, maybe not yourself: the first move is not the substance. It's having a conversation.
Ask what they're afraid of. What are their fears? What do they want? What do they want to release?
Find out the real medication list. Learn what's legally available near them.
There are a lot of considerations in doing this work, and it's really important, in my opinion, to go slow and use discernment. It's certainly not easy, and it can bring up a lot. And for some, it can be beneficial, because it can keep them dancing at 82.
When I dance with this guy who's 82, soon to be 83, I think: I want to be like that guy.
Questions and discussion
Christine Caldwell: I'm the founder and executive director of End of Life Psychedelic Care, so thank you, Josh, for talking about this subject that's near and dear.
For a couple of the folks here who may not know, there are several ongoing studies recruiting for conditions way beyond cancer, anxiety, or depression. There's a study recruiting Parkinson's patients at UCSF. Johns Hopkins is recruiting for a stroke survivor study as well as an early Alzheimer's study. There are several ongoing studies for pain. I love that the field is now expanding for those I consider closer to the end of life.
I also want to share that the people I get to work with, including Nancy and Betty who are on this call, and hundreds of people I know who do this work, may be end-of-life doulas, hospice nurses, hospice physicians, chaplains, people who understand what it means to die. They represent some thousands of clients they have served, the vast majority, probably 90%, older than 65. These medicines are very safe. I think the considerations Josh talked about are really critical, but just know that these medicines are so safe.
Josh: Thank you so much, Christine. You're doing great work, and I love hearing about everything going on with you and your team.
Nancy R: There's a new book out called Psychedelics and the Counterculture of Aging, by Abby Rosner. She's not in this work, she's a lifelong journalist, and she's older. I ran into her articles in Forbes and AARP and different media, and she's gotten really excited about taking a look at this very topic, which I find really timely and really necessary. It's another wonderful resource that's out there.
I love and respect so much the work that Chris does, and Betty. And I really want to point out that yes, the realization of end of life tends to come up more as we get older. And yet this work also needs to take into consideration all of the richness and opportunity in our older seasons. It's not all about end of life. That's one piece of it, and we don't want to turn away from that or ignore it.
I'm not saying to be Pollyanna-ish and Golden Girls about it. I'm saying there is a profound richness that can happen for many, many people in older life, in their 60s, 70s, 80s, 90s. So I want us to be really careful that when we look at the older population, we don't slide immediately toward end of life, equating the two, because that can overpower the whole other element I'm describing, which can be very profound and beautiful and thriving. Like your 82-year-old dancer. He's an example.
Josh: Thank you for sharing that.
Savannah asked in the chat: what specific markers do you look at when prescreening for heart health and psilocybin?
Again, I'm not a doctor, I'm a guide. I will often refer people to Dr. Ben Malcolm, the Spirit Pharmacist, at spiritpharmacist.com.
I'll look for whether there have been any surgeries, stents, atrial fibrillation, cardiovascular disease, blood pressure concerns, risk of stroke. I'll talk with someone first on Zoom and get a sense of their general health from the conversation, but typically I send someone to an actual doctor for an evaluation. I don't want to put that responsibility on myself, not being a licensed medical professional.
Closing
If you're in the New York City area, I run an in-person workshop called Psychedelic Consent, which is all about preparing to go into a psychedelic experience, whether on your own, with a facilitator one-on-one, or in a group, in a way that allows for the trust and safety to go deep.
Thank you for being here. You could have been anywhere in the world, and you chose to be here.
Josh Jupiter Brooklyn Balance LLC
josh@brooklynbalance.org Instagram: @brooklynbalanceintegration Linktree.com/BrooklynBalance
Sources and further reading
End-of-life research Grob et al., 2011 · Ross et al., 2016 · Griffiths et al., 2016 · Agin-Liebes et al., 2020
Safety Cardiovascular safety of psilocybin, 2026 · Tagen et al., 2023 · Psilocybin in Older Adults, 2026
Exercise adapted from Mary Cosimano, Johns Hopkins
Also mentioned Psychedelics and the Counterculture of Aging, Abby Rosner Dr. Ben Malcolm, spiritpharmacist.com End of Life Psychedelic Care
Educational content only. Not medical advice, and not a recommendation to use any illegal substance.
