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‘Older people, alcohol and other drugs’
Dr Barbara HunterProf Dan Lubman
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)
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
Trends in AOD consumption in older people
15%
5%
8%
3%
12%
10%
15%
2%
0%
2%
4%
6%
8%
10%
12%
14%
16%
Drink daily Short-term risk Smoke daily Prescription drugs
Popu
lati
on p
reva
lenc
e
Over 65 yrs
55 to 65 yrs
Source: NDSHS
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
Alcohol use in a community based sample of elderly men: associations with physical and mental health
Carolyn CoulsonA/Prof Julie PascoDr Lana WilliamsProfessor Michael BerkProfessor Dan Lubman
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+)
Usual number of drinks per day
Total None 1-2 3-4 5 P value
n=554 n=100 n=270 n=109 n=75
Age (year) 76.0 (71.0-82.0) 78.5 (72.3-83.0) 77.0 (72.0-83.0) 76.0 (69.5-81.0) 73.0 (69.0-78.0) 0.001
Body composition
Height (cm) 171.5 ± 6.8 170.8 ± 6.2 171.3 ± 6.9 171.8 ± 6.8 172.7 ± 6.8 0.29
Weight (kg) 74.9 ± 13.4 77.5 ± 15.1 79.3 ± 12.6 80.3 ± 11.1 84.8 ± 15.8a 0.004
BMI (kg/m2) 27.2 ± 4.1 26.6 ± 4.9 27.0 ± 3.7 27.2 ± 3.4 28.4 ± 4.7a b 0.03
BMI groups 0.005
<25 (kg/m2) 158 (29.4%) 40 (43.0%) 75 (28.3%) 30 (28.3%) 13 (17.6%)
25-29.9 (kg/m2) 267 (49.6%) 35 (37.6%) 138 (52.1%) 57 (53.8%) 37 (50.0%)
> 30 (kg/m2) 113 (21.0%) 18 (19.4%) 52 (19.6%) 19 (17.9%) 24 (32.4%)
Waist circumference
(cm) 100.0 (93.5-107.0) 98.0 (90.0-107.0) 99.0 (93.0-106.5) 101.0 (95.0-105.0) 103.0 (97.0-11.5) 0.008
Waist ³ 102cm 228 (43.9%) 35 (38.9%) 108 (42.0%) 48 (46.6%) 37 (53.6%) 0.24
Waist hip ratio 0.98 ± 0.05 0.98 ± 0.06 0.99 ± 0.05 0.99 ± 0.05 1.00 ± 0.05 0.16
% Fat mass 27.0 ± 6.6 25.7 ± 7.7 26.5 ± 6.2 28.0 ± 6.2 29.2 ± 6.7a b 0.001
% Lean mass 69.2 ± 6.3 70.5 ± 7.3 69.7 ± 5.9 68.2 ± 6.0 67.1 ± 6.4a b 0.001
Blood pressure
(mmHg)
Systolic 141.5 (130.5-157.5) 138.0 (130.5-152.1) 141.5 (128.5-159.6) 140.8 (132.5-151.0) 144.3 (133.3-158.1) 0.61
Diastolic 84.0 (76.0-93.1) 81.8 (74.9-92.6) 84.3 (77.8-93.0) 85.0 (76.0-95.4) 84.3 (75.5-92.0) 0.57
Adjusted for age, cigarette smoking and current use of 5+ medications
a: Significantly different from ≤2 drinks/dayb: Significantly different from 3-4 drinks/d
0
5
10
15
20
25
30
Any
psychopathology
mood disorder
(ever)
Mood disorder
(current)
A nxiety disoder
(ever)
Anxiety disorder
(current)
Current mood or
anx iety disorder
%
None
1-2
3-4
5+
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
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
AOD misuse in older people
62% Alcohol only
22%Benzos only
16%Other
AOD related ambulance attendances, 65+
Source: Ambulance VictoriaYear: 2010
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
AOD misuse in older people
17%Alcohol
82%Tobacco
1%Other
AOD related hospital admissions, 65+ (2004-08)
Source: VAED
AOD misuse in older people
65+ years1%
Under 64 years99%
Proportion in AOD treatment by age group
Source: ADIS
AOD misuse in older people
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
9.0%
10.0%
2006 2007 2008 2009
Proportion of pharmacotherapy clients aged 60+
Source: AIHWYear :2010
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)
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
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
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
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
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
Reconnexions For problems associated with benzodiazepine
use. Program not specifically designed for older people but adaptable to needs of older population
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
Prevention activities Health promotion activities:
public education, appropriate warning labels on pharmaceutical drugs, population-specific education activities
Preventive health services: early identification & effective interventions
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
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
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
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
ADF