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

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DrugInfo seminar: Older people and alcohol and other drugs

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