Addressing the needs of older substance misusers

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					Addressing the needs of older
    substance misusers
      Dr Millicent Chikoore,
     Dr Nicholas Seivewright
       Sheffield Care Trust
Background
 Increasing numbers of older substance
  misusers
 Increasingly use illicit drugs, not just
  prescribed drugs and alcohol
 Range of social, psychological, health
  problems
Crome & Bloor 2005, Gossop &Moos 2008.
Background (continued)
Our service
 Accustomed to young population
 Little provision for basic level medical services
 Referral to specialist medical service infrequent
 Does it appeal to older individuals (different
  behavioural and clinical manifestations) or is
  different approach required?
Method
   Analysis of clinical notes of all aged
    >50years in Sheffield substance misuse
    service in May 2008 , misusing substances
    other than alcohol.
Results
   n=40
           11


                     male
                     female


                29
Ages
                  20
                  18
                  16
no. of subjects




                  14
                  12
                  10
                   8
                   6
                   4
                   2
                   0
                       50-54   55-59         60-64   65-69
                                       age
Age at onset of misuse


        9



                         early onset user
                         late onset user
Source of substances
   n=40

             10
                      illicit&prescribe
                      d
                      prescribed

                  5   illicit
      25
Substances used

                    40
                    35
                    30
  no. of subjects




                    25
                    20
                    15
                    10
                     5
                     0
                         opi   benz   cann   coc   amph   LSD
Circumstances during which
misuse began
   n= 40
            7
                    12
                         self medication
                         iatrogenic
                         recreation
       9                 NOS
                         stressor
                    4

                8
Significant physical illness
   n=40

               2
           4

                        physical illness

                        no physical
                        illness
                        NOS


                   34
Impaired mobility(impacting on
outpt attendance)
   n=40

           9        10
                         impaired
                         mobility
                         no impaired
                         mobility
                         NOS



               21
Formal psychiatric diagnoses
   n=40
               1

           9
                        psychiatric
                        diagnosis
                        no psychiatric
                        diagnosis
                        NOS

                   30
2 deaths during period of analysis
Contributing factors
 Polydrug & alcohol misuse
 Initiation of heroin in later life (introduced by
  younger carer)
 MI
 Incontinence & pressure sores
 Self discharge from hospital
 Psychological factors-threatening behaviour
  leading to city-wide ban from primary care
  services, self harm by knifing in groin
Discussion
   Drug users are surviving into old age-captured by
    national data sets
   Unique factors in this age group-physical,
    psychological, social
   Younger people prioritised in addiction policies
   Large evidence base –epidemiological data,
    effective treatments, however older individuals
    often excluded
   No specific service provision in UK
Discussion continued
 Management of older adults requires
  different approach?
 Implications for services already stretched
 Specialist psychogeriatric services?
 Need for effective interventions in
  appropriate settings to reduce overall
  expenditure

				
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posted:4/8/2010
language:English
pages:16