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Substance Abuse in Older Adults
The document addresses substance abuse prevalence among older adults, highlighting that around 17% engage in such behaviors, often underreported due to misconceptions and social stigma. It provides screening tools like CAGE and AUDIT for identifying alcohol abuse, along with expert recommendations for treatment approaches tailored to this demographic. Consequences of substance abuse are noted, including various health risks and factors influencing usage patterns.
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Substance Abuse in Older Adults
- 1. Substance Abuse in OlderAdults Kevin W. O’Neil MD, FACP, CMD Internal Medicine and Geriatrics Chief Medical Officer
- 2. Objectives • Define theprevalence of alcohol and substance abuse among older adults. • Name two screening instruments for alcohol abuse in older adults and one screening instrument for prescription drug abuse. • Name three recommendations of an expert panel of SAMHSA (Substance Abuse and Mental Health Services Administration) for treatment of substance abuse.
- 3. • Overall prevalencein older adults about 17% • Reasons underreported: – Symptoms mistaken for dementia, depression, etc. – Older adults tend to hide substance abuse – Relatives may be ashamed and hide it Prevalence of Alcohol and Substance Abuse
- 4. • One drink= – 12 oz. beer – 4-6 oz. glass of wine – 1 ½ oz. distilled spirit • Heavy use: – Men >2/day – Women >1/day Alcohol Use
- 5.
- 6. • 2.5 millionolder adults • 21% of hospitalized adults over age 40 • Community Elderly – Heavy Alcohol Use: 3-25% – Alcohol Abuse: 2-9.6% • Primary Care Outpatients – 12% women – 15% men Prevalence of Alcohol Abuse (NIAAA)
- 7. • Early Onset –Continuing – 2/3 of older adults with alcohol abuse • Late Onset – Mostly previous users – Increased use – Or more vulnerable to EtOH effects Onset
- 8. • People 65and older consume more prescribed and OTC medications than an other age group. • Illicit drug problems rare in those not previously addicts or alcoholics.. • Opiates: Abuse or dependence rare unless a history of addiction. • Approximate 4 addicted out of about 12,000 morphine prescriptions. Drugs
- 10. • Chronic use:1.8% • Women > Men • 17-23% of all prescriptions for older adults • Chronic use >4 months not recommended • Treatment of insomnia should be limited to 7 to 10 days with frequent monitoring and reevaluation if the prescribed drug will be used for more than 2 to 3 weeks. Intermittent dosing at the smallest possible dose is preferred, and no more than a 30-day supply of hypnotics should be prescribed. Benzodiazepines Hypnotics
- 11. • Legal: notdriving • Marital: widowed • Occupational: retired • Tolerance and Withdrawal differ Consequences of Substance Abuse
- 12. • Hypertension • Cardiacarrhythmias • Myocardial infarction • Cardiomyopathy • Hemorrhagic stroke • Impaired immune function • Liver disease • GI disease • Osteoporosis • Psychiatric • Falls/fractures Health Consequences
- 13. • Drowsiness • Delirium •Forgetfulness • Dependence and withdrawal • 23% of adverse drug events in nursing homes Adverse Effects
- 14. • Past historyof alcohol use disorder (AUD) • Male gender (2x female) – 10% have history of AUD – 43% of LTC veterans have history of AUD • Loss of spouse • Other losses – Health, sensory, function, mobility • Psychiatric disorder • Nicotine, or other drug use disorder Alcohol Use: Risk Factors
- 15. • Female gender •Older age • Poor health • Widow • Divorce • Anxiety, depression, stress Risk Factors: Drugs
- 16. • Cognitive impairment •Tremors, seizures • Irritability, mood changes, sleep disturbances • Unexplained pain • Poor hygiene, neglect • Abnormal liver function tests • GI complaints • Malnutrition • Urinary incontinence • Gait disturbance, falls • Slurred speech Red Flags
- 17. • Patient feelsthreatened • Assure confidentiality • Use non-judgmental approach • Don’t rush • A medical approach is better: “The alcohol is affecting your liver enzymes.” • Build on problems and causal link with alcohol/drug use • You and the patient against their problems Approach To Patient
- 18. • Talk toothers to confirm story – Spouse – Other family – Friends • Obtain permission! Collateral Information
- 19. • Alcohol – CAGE –MAST – AUDIT – Maximum in last year • Other drugs – Use despite consequences Screening
- 20. • C: Haveyou ever felt the need to Cut Down? • A: Have you ever been Annoyed at criticism of your drinking? • G: Have you ever felt Guilty about your drinking? • E: Have you ever had a morning Eye-opener to get going? CAGE
- 21. 21 • Simple, self-scoringtest • Twenty-two questions • Yes or No Answers • Scoring: • 0-2: No apparent problem • 3-5: Early or middle problem drinker • 6 or more: Problem drinker MAST: Michigan Alcoholism Screening Test
- 22. AUDIT: Alcohol UseDisorders Identification Test • Developed by the World Health Organization • Clinician-administered and self-report version • Ten questions • First three questions deal with quantity and frequency of use • Geriatric primary care out-patients • CAGE: 5% prevalence • AUDIT: 18% prevalence
- 23. • Eight itemquestionnaire • Obtains information from patients about lifetime use of substances • Current substances use associated problems over the last 3 months (tobacco products, alcohol, cannabis, cocaine, amphetamine-type stimulants, sedatives, sleeping pills, hallucinogens, inhalants, opioids, ‘other’ drugs) • Can identify a range of problems associated with substance use: – acute intoxication – regular use – dependent or ‘high risk’ use – injecting behavior. ASSIST: Alcohol, Smoking, and Substance Involvement Screening Test
- 24. • Evidence-based practiceused to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs. • SBIRT model was incited by an Institute of Medicine recommendation that called for community-based screening for health risk behaviors, including substance use. SBIRT: Screening, Brief Intervention, and Referral to Treatment http://www.integration.samhsa.gov/clinical-practice/sbirt
- 25. • Dementia/Delirium – MMSE –SPMSQ – Mini-Cog – SLUMS – CAM • Functioning – ADLs – IADLs Cognition/Function
- 26. • Feedback onalcohol/drug use and consequences • Reasons for use • Reasons to cut down/stop – Health – Mental capacity – Independence • Goals, written agreement Brief Intervention
- 27. • Readiness forChange (Prochaska) – Pre-Contemplation – Contemplation – Preparation – Action • Need to believe the benefits of change Motivational Counseling
- 28. • Age-specific treatmentand pace • Focus on: – Depression, losses – Restoration of self-esteem and social supports • Staff experienced with elders • Links with services for elders Treatment
- 29. “ Alone wecan do so little; together we can do so much.” — Helen Keller 29
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