The article I chose is from the Journal of Addictions Nursing and is titled Assessment Protocol for Older Adults with Substance Use. This is a quality improvement project that focused on the needs of older adults with substance use disorders. It points out that older adults have specific physical, mental, and neurological issues that need to be addressed in addition to their addiction treatment. This study identifies the need for additional education for nurses and assessments specific to the older adult population suffering from addiction. The Fulmer SPICES tool assesses for six common geriatric syndromes. They implemented the use of the Fulmer SPICES tool for all patients age 55 years and older. What they found was after the education was provided to the nurses, their posttest scores increased. In the medical record audits, they found a 235% increase in the identification of patients at-risk for adverse events. Sleep disturbances were the most significant difference found in the Fulmer SPICES tool. Interventions based on the results of this tool may help to improve outcomes.
Mcrae, K. R. (2019). Assessment protocol for older adults with substance use. Journal of Addictions Nursing, 30(4), 242–247. doi: 10.1097/jan.0000000000000306
Interesting article! I was curious to find information on why adult substance abuse is on the rise. Historically older adults have not demonstrated high rates of alcohol or other drug use compared with younger adults or presented in large numbers to substance abuse treatment programs” This has created a misconception that older adults do not use or abuse substances. This age group has been under identified for decades, many assuming that as one gets older passing through young adulthood drug abuse is non-existent. Alcohol continues to be the most prevalent followed by nicotine and illicit drugs such as marijuana, cocaine and methamphetamine. (Kuerbis A., Sacco P., & Moore A, 2014) Within a healthcare setting the rates of AUD among older adults ranger up to 22%, although these rates are lower than younger adults they are likely impacted by under reporting. I also found an article that researched a modified CAGE tool, to examine the sensitivity, specificity and receiver operating characteristics curve. The study omitted the C, ‘cut-down” item from the assessment, significantly improved specificity, given with ease of administration. (Hinkin et al.,2010)
Kuerbis A., Sacco P., Blazer D., & Moore A. (2014) Substance Abuse Among Older Adults. Clinics in Geriatric Medicine. 2014; 30 (3) : 629-654.
HInkin C., Castellon S., Dickson-Fuhrman E., Duam G., Jaffe J., & Jarvik L., (2010) Screening for Drug and alcohol Abuse Among Older Adults using a Modified Version of the CAGE. 2010; 10(4)
This is great article for journal club. It’s important to increase nursing staff knowledge related to older populations because usually elderly people have other comorbidities that could affect the treatment plan. Some of the most common diagnoses include depression, anxiety and heart disease. In addition, several studies have revealed that there is not enough research for substance abuse in elderly. “Substance use disorders among the elderly are a growing public health concern but there is a limited evidence base on interventions designed specifically for this population group” (Bhatia et al., 2015).
Bhatia, U., Nadkarni, A., Murthy, P., Rao, R., & Crome, I. (2015). Recent advances in treatment for older people with substance use problems: An updated systematic and narrative review. European Geriatric Medicine, 6(6), 580-586.
A study conducted by Music, et al. (2019), highlights the importance of health professionals awareness of the characteristics and trends of drug abuse amongst older adults (specifically Baby Boomers) when considering health interventions. Music, et al. (2019) found that amongst adult opioid users there often existed “triple comorbidities of chronic pain, mental health issues, and substance use disorders” and those interventions needed to simultaneously address all three issues as well as a focus on sleep management. Their study found that amongst older adults, 69% of low dose opioid users were female, 48% were white, 43% were high income, and 27% were 70-75 years old. The largest percentage of high dose opioid users were younger men who had poor health, and this is also the population with the highest rates of death, overdoses, and substance abuse problems. High dose users in all adult age groups also had back pain (77%) and 32% used prescription sleep medication. Statistics in drug use indicate a trend toward increased risk of death, overdose, and substance abuse problems in the Baby Boomer population, thus making it imperative for health professionals to modify interventions for an older population.
Reference
Music, S., Wang, S., Slindee, L., Kraemer, S., Yeh, C. (2019). Prevalence and characteristics associated with high dose opioid users among older adults. Geriatric Nursing, 40 (1), 31-36. Retrieved from https://doi.org/10.1016/j.gerinurse.2018.06.001
Thank you for the great comments and articles to review. One rationale I found for the increase of substance abuse in order adults is the higher drug use rates of the baby boomer generation. Because of this, illicit drug use in adults over age 50 are expected to increase from 2.2 percent to 3.1 percent between 2001 and 2020. That translates to roughly 2.9 million older adults in the United States. Despite the increase in drug use in the older generation, alcohol remains the primary substance of abuse. Given these increases, it is important to provide additional education to nurses caring for older adults on the effects of alcohol and drug abuse and withdrawal.
Mattson, M., Lipari R. N., Hays, C., Van Horn, S. (2017, May 11). A Day in the Life of Older Adults: Substance Use Facts. Substance Abuse and Mental Health Services Administration (US). https://www.ncbi.nlm.nih.gov/books/NBK436750/#_NBK436750_pubdet_