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Lucy Burns, UNSW, Drugs, Ageing and Homelessness in Australia


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Drugs, Ageing and Homelessness in Australia, presented at the Brain Injury Forum in April.

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Lucy Burns, UNSW, Drugs, Ageing and Homelessness in Australia

  1. 1. Drugs, ageing and homelessness inAustraliaLucy BurnsNational Drug and Alcohol Research Centre, University of New SouthWales, Sydney, Australia
  2. 2. Structure• Evolution of the “baby-boomer” generation• What this means for drug use and ageing inAustralia• Housing issues• What does this mean for policy and practice?
  3. 3. Alcohol use and problems are not new…."...alcohol has existed longer than all human memory. It hasoutlived generations, nations, epochs and ages. It is a part ofus.For most of us it will continue to be the servant of man (andwoman) but will always be the master of some."Our recent historyMorris Chaftez, Founding director, National Institute on Alcohol Abuse and Alcoholism.OUR RECENT HISTORY
  4. 4. Birth of the baby boomers: 1946-64• End of WW2 in 1945 Australias ex-service men and womenreturned 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 born1946-51: “baby boomer generation”• Increased migration to Australia through negotiated agreements with othergovernments and international organisations e.g a system of free or assistedpassages for United Kingdom residents
  5. 5. 1950s and 1960s: Teenagers and young adults• Increased advances in science and technology• Widespread testing and use of new synthetic pharmaceuticalsBig Pharma• LSD testing , wider use of new drugs in psychiatryexperimentation with mind altering substancesPrescription 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. 6. 1970s and 80s• Between 1962-1972 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. 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 anincreased effect• Physiological changes (smaller body volume/mass) = increased impact• Leads to accelerated ageing: impaired stem cell regeneration and increased ratesof cell death• When 40: biological age of 60• Heightened use of medications that interact with alcohol, such as sedatives andtranquillisers• Poor mental and physical healthWomen’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. 8. What are the contemporary drugpatterns in older Australians
  9. 9. Daily alcohol use by age: 20070510152025Male Female14-1920-2930-3940-4950-5960+More daily useLess amount but more effect
  10. 10. Places of alcohol consumption0102030405060708090100Home FriendshouseLicensedpremisesRestaurants Parties14-1920-2930-3940-4950-5960+Increasing consumption at homeIncreasing social isolationMedication interaction/ Increased falls
  11. 11. Oxycodone prescriptions per thousand population, by 10 year agegroup,2002 to 20080501001502002503003504002002/03 2003/04 2004/05 2005/06 2006/07 2007/08numberper1,000population20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80+Most by older groupsIncreasing over timeInteraction with other drugs/ alcohol
  12. 12. Overall number of adults aged 50 or olderwith substance use disorder projected todouble by 2020INCREASED SUBSTANCE USE = POORMENTAL HEALTH =INCREASED LIKELIHOODOF LOSS OF HOUSING
  13. 13. Linking substance use and homelessness inolder Australians
  14. 14. Who are homeless in Australia?100,000 Australians homeless each night, sleeping in differentplacesMost staying with friends/relativesHalf are under 24 and 10,000 are childrenIncreasing number of older people homeless (18% 2006Census Counting the Homeless)105,00016,000 20,00047,00021,600020,00040,00060,00080,000100,000120,000total roughsleepers/improviseddwellings (primary)SAAP accommodation(secondary)staying withfriends/relatives(secondary)boarding houses(secondary/tertiary)Homeless Census 2006
  15. 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 – more likely to have mental health problems
  16. 16. Structural factors related to homelessness“There is a great divide in Australia between those older people whohave secure and stable housing and those who live precariously inprivate rental accommodation that is unsafe, expensive andinsecure”.Private: Chronic undersupply and high cost• Not age-appropriate: Unwillingness of many landlords to modify houses inline with support needs, housing poorly suited to needs of older people.Social: Limited amount of age appropriate social housingAged care: Residential care required for some BUT• Mainstream services ill equipped• Premature ageing – 54 to 50 and over• Special care needs around ARB
  17. 17. Substance use and homelessness in older people• Substance use patterns more risky• exposed to elements and violence, poor nutrition, lack of opportunitIesfor hygiene• Alcohol problems and traumatic brain injury highly prevalent• History of homelessness + problematic alcohol use + traumatic braininjury = accelerated cognitive deficits• BUT do not necessarily meet the age criteria for access to services althoughmeet physical criteria• THEREFORE Little or no targeted services available for this group
  18. 18. Brain injury among olderwith substance useproblems
  19. 19. Study aims and methodsAim: To describe the association between alcohol use and cognitiveprocesses in older homeless people and implications for servicesMethod:• 50 Face-to-face client participant interviews• Assess demographics, physical and mental health, social support,cognitive performance, use of services• Series of in-depth interviews with key experts in the areas of agedcare and homelessness to determine “gold standard” in care forhomeless people who are also alcohol dependent.
  20. 20. Methods• Clients were recruited from Haymarket Centre for homeless people in innerSydney.• Eligible if 45 years or older and homeless in past 6 months.• Homelessness defined as:• Primary homelessness: sleeping rough on the street or in a car or othermakeshift dwelling• Secondary homelessness: staying in an accommodation service, hotel ormotel, or staying with family or friends because they had nowhere elseto live• Tertiary homelessness: living in a boarding house/hostel or caravan(insecure tenure)
  21. 21. DemographicsCentre% male 70.4Mean age 49.0% Australian born 74.1% identifying as Indigenous 14.8% 10yrs or less education 74.0Mean age first left school 15.0Mean age first employed 16.0% not in the labour market 74.1% in receipt of government benefit 96.3% ever married 51.8% currently in serious, long-term relationship 7.4% ever had children 66.7
  22. 22. Almost all participants had ever slept rough (94%) and stayed in crisisaccommodation (90%).Cycling though different typesEver homeless (%) Mean age (yrs)Slept rough 94.0 31.2Family/ friends 56.0 24.6Stayed in motel 68.0 32.7Crisis accommodation 90.0 33.8Boarding/ rooming house 74.0 29.1Caravan 36.0 26.4Homelessness history
  23. 23. Cycles of homelessnessThe earliest mean age of onset for the different homelessness states• 25 years of age for staying with family and friends• 26 years for staying in a caravan,• 29 years for boarding/rooming house, and• 31-34 years for sleeping rough, crisis accommodation and staying in a motel.This pattern suggests participants experienced precarious housing situationsbefore first experiencing primary homelessness and accessing supportedaccommodation services.
  24. 24. Condition % n Age atdiagnosisTreated in lastmonth nTreated in lastmonth %Depression 53 56 29(1.6) 15 27Liver disease 41 43 32(1.5) 14 9Anxiety 39 41 26(1.6) 11 27Psychosis 31 32 25(1.5) 9 28Asthma 28 29 15(3.3) 7 24Feetproblems23 24 35(3.7) 3 13Headaches 25 26 29(3.7) 2 8Epilepsy 13 14 25(2.9) 6 43Health issuesUncontrolled chronic conditions; mental health, asthma andepilepsyBSI: 98th percentile for psychological distress
  25. 25. Alcohol variable %Mean onset of regular drinking 17Mean maximum drinks in one day 26% ever abstinent 71Mean number of quit attempts 19% ever talked to health professional about drinking 68% ever received helpful/effective treatment 50% received treatment in past 12 months 28% ever hospitalised overnight because of alcohol 50Mean onset of first hospitalisation 30% ever attended self-help group 42% attended meeting in past 12 months 14Alcohol use95% lifetime alcohol dependence/ 75% currently alcoholdependent
  26. 26. % Past month substance use4423 2116405101520253035404550
  27. 27. Alcohol Related Brian Injury• Brain organ most sensitive to the toxic effects of chronic alcoholconsumption• International literature: high exposure to brain injuries from falls andassaults 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 andcoordination.• Korsakoffs psychosis: problems “laying down” new information) that is themost striking.• For example, these patients can discuss in detail an event in their lives,but an hour later might not remember ever having the conversation.
  28. 28. Brain injury% who experienced eachtype of ABImean number of incidentsamong those whoexperienced each ABITraumatic brain injury (TBI) 59.2 7.6Hypoxic events 53.1 4.3Alcohol related brain injury(ARBI)65.3 16.9Infectious processes 6.1 0.5• Prevalence of any acquired brain injury (ABI) 88%• Montreal cognitive assessment ; mild cognitive impairment• similar scores to people with Alzheimers Disease• Brief Symptom Inventory scored in 98th percentile for psychological distressSuggests there is a need for neuropsychological assessment in this group.
  29. 29. So, what will we see?• More older Australians who are homeless and alcohol dependent• Poor mental health : mood and anxiety disorders, psychoses and cognitivedisorders e.g dementia, delirium and Wernicke-Korsakoff syndrome.• Poor physical health: osteoporosis; ischemic heart disease, stroke, type 2diabetes, colorectal cancer, infection, poor dental care, , lung cancerbronchitis (smoking), falls, liver cirrhosis, dementia, and adverse eventsarising from medication mismanagement.• End stages of long standing BBVs – HIV, Hep C, Hep B• Increased social exclusion: sever links with family and non-drug using friends,death of partners
  30. 30. What it means for housing• Housing that accommodates any disabilities, does not requireextensive maintenance and located close to amenities and publictransport.• Located in familiar neighbourhoods.• Home based care with integrated services – allows for ageing in place• Successful housing associated with previous stable accommodationhistory, revived contacts with family, taking up activities, regular helpfrom housing support workers• Gold standard services EXIST eg Wintringham
  31. 31. Conclusions• “Irrespective of presence of brain injury or anti-social behaviour theseindividuals are entitled to receive care and support that is both appropriateto their needs and which promotes empowerment and independence”• Housing should meet the needs and requirement of this groupBUT• Lack of affordable housing appropriate to needs of older withsubstance use disorders• Lack of sufficient income to maintain an adequate standard of living
  32. 32. “Individuals who are most marginalised will carrythe burden”Further details: Lucy Burns YOU