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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

Published in: Health & Medicine
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  • 1. ‘Older people, alcohol and other drugs’ Dr Barbara HunterProf Dan Lubman
  • 2. 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)
  • 3. 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
  • 4. Trends in AOD consumption in older people
  • 5. 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
  • 6. 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
  • 7. 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+)
  • 8.
  • 9.
  • 10.
  • 11. 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
  • 12.
  • 13. 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
  • 14. 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
  • 15. AOD misuse in older people
  • 16. 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
  • 17. AOD misuse in older people
  • 18. AOD misuse in older people
  • 19. AOD misuse in older people
  • 20. 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)
  • 21. 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
  • 22. 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
  • 23. 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
  • 24. 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
  • 25. 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
    For problems associated with benzodiazepine use. Program not specifically designed for older people but adaptable to needs of older population
  • 26. 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
  • 27. Prevention activities
    • Health promotion activities: public education, appropriate warning labels on pharmaceutical drugs, population-specific education activities
    • 28. Preventive health services: early identification & effective interventions
    • 29. 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
  • 30. 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
  • 31. 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
  • 32. 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