Presentation by Dan Lubman, Director, Turning Point Alcohol & Drug Centre, and Professor of Addiction Studies at Monash University. 5 September 2011

1. ‘Older people, alcohol and other drugs’ Dr Barbara HunterProf Dan Lubman

2. 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)

3. 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

4. Trends in AOD consumption in older people

5. 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

6. Alcohol use in a community based sample of elderly men: associations with physical and mental health Carolyn Coulson A/Prof Julie Pasco Dr Lana Williams Professor Michael Berk Professor Dan Lubman

7. 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+)

11. Adjusted for age, cigarette smoking and current use of 5+ medications a: Significantly different from ≤2 drinks/day b: Significantly different from 3-4 drinks/d

13. 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

14. 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

15. AOD misuse in older people

16. 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

17. AOD misuse in older people

18. AOD misuse in older people

19. AOD misuse in older people

20. 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)

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

28. Preventive health services: early identification & effective interventions

30. 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

31. 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

32. 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