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DrugInfo seminar: Older people and alcohol and other drugs
 

DrugInfo seminar: Older people and alcohol and other drugs

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Presentation by Dan Lubman, Director, Turning Point Alcohol & Drug Centre, and Professor of Addiction Studies at Monash University. 5 September 2011

Presentation by Dan Lubman, Director, Turning Point Alcohol & Drug Centre, and Professor of Addiction Studies at Monash University. 5 September 2011

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    DrugInfo seminar: Older people and alcohol and other drugs DrugInfo seminar: Older people and alcohol and other drugs Presentation Transcript

    • ‘Older people, alcohol and other drugs’ Dr Barbara HunterProf Dan Lubman
    • Definitions
      “Older people”
      Describes people >60yrs
      Encompasses vast array of different people with very different physical and psychological needs (cf. people in their 60s with 80s)
      Definition of “older people” varies in the literature (55, 60 or 65 plus)
    • Older Australians – key facts
      Older Australians constitute 13.6% of population (24% by 2051)
      Health of older Australians has been identified as a key economic and medical challenge for the coming decades
      Ageing is associated with biological changes in the metabolism of alcohol and other drugs
      Estimated that 25% consume 5 or more prescription medications concomitantly
    • Trends in AOD consumption in older people
    • Drugs of concern: alcohol
      Is the most commonly consumed (and misused) drug among people >60yrs
      Older people are more likely to consume alcohol daily than other age groups & are more likely to be consuming multiple prescription medications
      In 2007, 15% of people aged >65yrs consumed alcohol daily & 5% were at risk of short term alcohol related harm
    • Alcohol use in a community based sample of elderly men: associations with physical and mental health
      Carolyn Coulson
      A/Prof Julie Pasco
      Dr Lana Williams
      Professor Michael Berk
      Professor Dan Lubman
    • Method: Baseline sample
      Design: a population-based observational study
      Participants were an age stratified, random sample of the community enrolled in the Geelong Osteoporosis Study (GOS)
      N=1,420 men (20yrs+)
      N=554 men (65yrs+)
    • Adjusted for age, cigarette smoking and current use of 5+ medications
      a: Significantly different from ≤2 drinks/day
      b: Significantly different from 3-4 drinks/d
    • Drugs of concern: prescription drugs
      Prescription drugs next most commonly used & misused (although at very low levels)
      Growing awareness of potential pharmaceutical drug misuse among older people (e.g. benzos)
      3% of older people reported using pain killers or non-opioid analgesics for non-medical purposes
    • Drugs of concern: illicit drug use
      Based on US research, there is concern that higher levels of illicit drug use may be seen in Australia among older people as the ‘baby boomers’ enter their 60s, 70s & 80s
      Women are less likely to abuse illicit drugs but are more likely to engage in problematic use of alcohol or prescription drugs
    • AOD misuse in older people
    • Hospital admission & ambulance attendance data
      Analysis of Victorian hospital admission & ambulance attendance data showed an increase in the rate of older people (>65yrs) experiencing significant alcohol-related harm (Hunter, Lubman & Barratt 2011)
      Ambulance attendance rates for alcohol intoxication:
      2004: 3.3 persons per 10,000 persons
      2008: 8.2 persons per 10,000 persons
      Hospital admission rates for alcohol intoxication:
      2004: 64.5 persons per 10,000 persons
      2008: 73.9 persons per 10,000 persons
    • AOD misuse in older people
    • AOD misuse in older people
    • AOD misuse in older people
    • Factors influencing consumption
      No studies in Australia that map changing patterns of AOD use in older people
      Factors that may influence use (and misuse) of alcohol:
      Attitudes of social group (e.g. supportive of heavy drinking)
      Financial resources
      Life history of alcohol consumption
      Health (e.g. a decline in health may lead to reduced drinking)
      Use of alcohol as a coping strategy (e.g. pain, bereavement, anxiety and/or depression)
    • Categorisations of misuse: identifying the problem & treatment decisions
      Early onset AOD misuse – long term problems
      Can be associated with a range of physical health impacts and an increased likelihood of psychiatric & medical co-morbidity in old age
      Late onset AOD misuse – recently developed problems
      Positive or negative lifestyle changes may influence onset e.g. retirement, loss of spouse or close friends, loss of health, increase in free time, reduced responsibilities, changing peer group
      Inappropriate prescribing or unintentional misuse of pharmaceutical drugs can result in adverse drug reactions
    • Health impacts of AOD use
      Health impacts of risky/high risk alcohol consumption
      Alcohol liver cirrhosis, haemorrhagic stroke, falls, hip fracture, cardiac arrhythmias, alcohol dependence, reduced cognitive performance, adverse drug reactions, worsening mental health, increased suicide risk
      Limited evidence supporting health benefits of moderate alcohol consumption
      Ageing bodies gradually lose the ability to metabolise alcohol & other drugs making co-occurring conditions more likely, especially for women
    • Treatment seeking: a hidden issue
      Currently few older people within specialist AOD treatment system in Australia. Why?
      Health care practitioners: lack of awareness, reluctance to ask, may mistake symptoms of alcohol related harm for other health problems
      Older people: lack of awareness, sense of shame, reluctance to discuss
    • Early identification
      What to ask?
      Few simple questions about AOD use (amount, frequency)
      AUDIT-C, ARPS (Alcohol Related Problems Survey: higher sensitivity with older adults), ASSIST
      When to ask?
      When doing any assessment (red flags: falls, gastric complaints)
      How to ask?
      As part of routine assessment, without emphasis, not hurried
      NB: Include medication assessment – high risk of adverse reactions in cases of 4+ medications
    • Examples of AOD treatment and/or screening programs
      The Older Wiser Lifestyles (OWL) program
      Specialist AOD treatment for older people (Peninsula Health)
      Florida Brief Intervention and Treatment for Elders (BRITE)
      Emergency & primary care settings for ≥55yrs
      Reconnexions
      For problems associated with benzodiazepine use. Program not specifically designed for older people but adaptable to needs of older population
    • Facilitating treatment delivery to older people
      Promote alternate strategies to manage insomnia and stress
      Outreach services
      Flexible length of treatment
      Age-specific group sessions, or embedding a social component into the treatment program
      Co-location of services or strong co-ordination of care providers (primary health care & AOD support)
      Incorporate the biological, mental health, social, physical & spiritual needs of the client into treatment
      Install ramps & hand rails, use appropriately-sized text, provide appropriate seating, minimise distance to be travelled within the service, provide transport to and from the service
    • Prevention activities
      • Health promotion activities: public education, appropriate warning labels on pharmaceutical drugs, population-specific education activities
      • Preventive health services: early identification & effective interventions
      • Little activity on these fronts in Victoria, except OWL program (Peninsula Health)
    • Treatment implications
      Older people with AOD misuse disorders may not be identified
      Need to embed screening for AOD in a range of client/patient contact situations
      Multiple medications and AOD use may result in adverse consequences
      Prescribers need to enquire about and consider current AOD when prescribing
    • Treatment implications
      Services not established to cater to the AOD needs of older people
      Secondary consultation model whereby AOD services consult with geriatrician, aged care services consult with AOD specialist
      Older people may require support from multiple services
      Cross sector case management approach
    • Future research opportunities
      Identifying factors that motivate use and changes in use of AOD as people age
      The influence of culture, social norms & peer influences on AOD use in older people
      Social, economic, physical & mental health harms associated with AOD use by older people
      Identifying a level of AOD consumption that is ‘safe’ or low risk for older people
      Development and evaluation of AOD treatment models/programs targeted at older people
    • Acknowledgements
      Geelong Osteoporosis Study
      Carolyn Coulson
      A/Prof Julie Pasco
      Dr Lana Williams
      Prof Michael Berk
      Population Health – Turning Point
      Sharon Matthews
      Dr Belinda Lloyd
      ADF