DrugInfo seminar: Building an older adult treatment service


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Presentation given by Simon Ruth, Director, Complex Services, Community Health, Peninsula Health, 5 September 2011.

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  • Thanks for having us. Introduce selves.
  • Cognitive decline Higher BAC from dose Increased injuries, falls Medication interactions Increased suicides Sleep disorders Increase in body fat Decrease in body water content Decrease in gastrointestinal tract functions Decrease in albumin Decrease in liver function Decrease in kidney function Under-reporting of symptoms Problems are not recognised Assumption that older adults do not respond to treatment Symptoms being perceived as a function of age Low expectations regarding any improvement in older adults’ quality of life even if treatment is successful
  • Stronger direction 12 Step? Reporting? Family work Better assessments Pharmacotherapy exit points
  • Self-report Age-specific Good psychometric properties: Sensitivity = 93% (cf. 28% for AUDIT) Specificity = 63% (cf. 100% for AUDIT)
  • DrugInfo seminar: Building an older adult treatment service

    1. 1. Building an Older Adult Treatment Service <ul><li>Simon Ruth – Director, Complex Service </li></ul><ul><li>Peninsula Health </li></ul>
    2. 2. Background <ul><li>Victorian Travelling Fellowship </li></ul><ul><li>13 Older Adult services visited </li></ul><ul><li>Older Wiser Lifestyles Program </li></ul><ul><ul><li>Treatment </li></ul></ul><ul><ul><li>Prevention </li></ul></ul>
    3. 3. Why? <ul><li>Alcohol use disorders in the elderly are common </li></ul><ul><li>Alcohol problems in the elderly are insufficiently treated </li></ul><ul><li>Physiological changes and increased isolation put older people at increased risk of developing AOD issues </li></ul><ul><li>Use of drugs in combination with alcohol increases risk for older people </li></ul><ul><li>Just maintaining life long drinking patterns is likely to put older adults at risk </li></ul><ul><li>Older adults are poorly educated about AOD issues and are not targeted by public campaigns. </li></ul><ul><li>We have an ageing community </li></ul><ul><li>2003/04-2007/08 Over 65s = 0.8% of AOD treatment episodes </li></ul>
    4. 4. Questions. <ul><li>How can services engage older persons in alcohol and drug treatment? </li></ul><ul><li>What constitutes age appropriate and effective alcohol and drug treatment for older persons? </li></ul><ul><li>What factors assist older persons to change their drug using behaviours? </li></ul><ul><li>What skills and knowledge do treatment staff require? </li></ul>
    5. 5. Access <ul><li>Acknowledge Issue </li></ul><ul><li>Develop Relevant Services </li></ul><ul><li>Raise Awareness </li></ul><ul><li>Be Useful and Convenient </li></ul><ul><li>CALD Aware </li></ul><ul><li>Be Accessible </li></ul><ul><li>Legislation </li></ul>
    6. 6. Treatment <ul><li>Treatment requires longer episodes of care and needs to be slower, gentler, holistic and more flexible </li></ul><ul><li>Treatment is medically more complex </li></ul><ul><li>Loss, hopelessness and social isolation are more prevalent amongst older adults </li></ul><ul><li>Treatment is more likely to involve significant others </li></ul><ul><li>Treatment agencies are more likely to inadvertently create barriers to treatment </li></ul><ul><li>Non-medicated withdrawal is inappropriate </li></ul><ul><li>Collaborative </li></ul>
    7. 7. Early Onset or Late Onset <ul><li>Early Onset alcoholism : </li></ul><ul><li>A long history of chronic alcoholism </li></ul><ul><li>Early drinking age between 14-20 years. </li></ul><ul><li>High tolerance to alcohol that has increased over time </li></ul><ul><li>Multiple attempts to quit, treatments and withdrawal experiences. </li></ul><ul><li>Family History more prevalent </li></ul><ul><li>Cognitive loss more severe, less reversible </li></ul><ul><li>Late onset alcoholism : </li></ul><ul><li>Drinking problems began post 50 years of age. </li></ul><ul><li>Significant Transitions or loss late in life </li></ul><ul><li>Increased toxic effects related to lower tolerance and mixture of medications </li></ul><ul><li>Shame and grief. </li></ul><ul><li>Family History less prevalent </li></ul><ul><li>Cognitive loss less severe, more reversible </li></ul>
    8. 8. Transitions & Spirituality <ul><li>Older adults face loss of employment, loss of mobility, loss of health, loss of peers, loss of partner, loss of hope and loss of identity. </li></ul><ul><li>Older adults feel unneeded and useless </li></ul><ul><li>“ Spirituality is about learning to be comfortable with who you are rather than what you do” </li></ul>
    9. 9. Contributing Factors <ul><li>Health - Physical & Mental </li></ul><ul><li>Poverty </li></ul><ul><li>Shame </li></ul><ul><li>Social isolation </li></ul><ul><li>Abuse </li></ul><ul><li>CALD </li></ul>
    10. 10. Workforce <ul><li>Knowledge of, or background in, gerontology particularly in relation to medications used by older adults </li></ul><ul><li>Respect for older adults and their place in the community </li></ul><ul><li>Patience and perseverance </li></ul><ul><li>Strong boundaries. </li></ul><ul><li>Resilience </li></ul><ul><li>Qualifications in AOD treatment </li></ul><ul><li>Partnerships </li></ul>
    11. 11. Prevention – Reducing Risky Drinking <ul><li>VAAP funded </li></ul><ul><li>Prevent late onset issues </li></ul><ul><li>Educate about alcohol, medications and standard drinks </li></ul><ul><li>Alcohol Related Problems Scale (ARPS) </li></ul><ul><li>www.wisedrinking.org </li></ul>
    12. 12. Future <ul><li>Getting older </li></ul><ul><li>Baby boomers are more demanding of health services </li></ul><ul><li>Likely broader range of drugs </li></ul><ul><li>Likely more health issues associated with ageing and chronic disease </li></ul>
    13. 13. Victorian Alcohol and Drug Association - VAADA <ul><li>Easier entry and targeted AOD services for older adults </li></ul><ul><li>A pilot drug treatment project to address the gap in AOD services for older adults. The project should include outreach, project coordination, medical support coupled with funding for research and evaluation. This should then translate into broader program and service delivery </li></ul>
    14. 14. Thanks <ul><li>St John of God Healthcare </li></ul><ul><li>Victorian Government </li></ul><ul><li>Australian Drug Foundation </li></ul><ul><li>The OWL team </li></ul><ul><li>Simon Ruth </li></ul><ul><li>[email_address] </li></ul>