Building an Older Adult Treatment Service

Simon Ruth – Director, Complex ServicePeninsula Health

Background

• Victorian Travelling Fellowship

• 13 Older Adult services visited

• Older Wiser Lifestyles Program– Treatment– Prevention

Why?• Alcohol use disorders in the elderly are common • Alcohol problems in the elderly are insufficiently treated • Physiological changes and increased isolation put older

people at increased risk of developing AOD issues• Use of drugs in combination with alcohol increases risk

for older people • Just maintaining life long drinking patterns is likely to put

older adults at risk• Older adults are poorly educated about AOD issues and

are not targeted by public campaigns.• We have an ageing community• 2003/04-2007/08 Over 65s = 0.8% of AOD treatment

episodes

Questions.

• How can services engage older persons in alcohol and drug treatment?

• What constitutes age appropriate and effective alcohol and drug treatment for older persons?

• What factors assist older persons to change their drug using behaviours?

• What skills and knowledge do treatment staff require?

Access

• Acknowledge Issue• Develop Relevant

Services• Raise Awareness

• Be Useful and Convenient

• CALD Aware• Be Accessible

• Legislation

Treatment

• Treatment requires longer episodes of care and needs to be slower, gentler, holistic and more flexible

• Treatment is medically more complex• Loss, hopelessness and social isolation are more

prevalent amongst older adults• Treatment is more likely to involve significant others• Treatment agencies are more likely to inadvertently

create barriers to treatment• Non-medicated withdrawal is inappropriate• Collaborative

Early Onset or Late Onset

Early Onset alcoholism :• A long history of chronic

alcoholism• Early drinking age between 14-

20 years.• High tolerance to alcohol that

has increased over time• Multiple attempts to quit,

treatments and withdrawal experiences.

• Family History more prevalent• Cognitive loss more severe, less

reversible

Late onset alcoholism :• Drinking problems began post 50

years of age.• Significant Transitions or loss

late in life• Increased toxic effects related to

lower tolerance and mixture of medications

• Shame and grief.• Family History less prevalent• Cognitive loss less severe, more

reversible

Transitions & Spirituality

• 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.

• Older adults feel unneeded and useless

• “Spirituality is about learning to be comfortable with who you are rather than what you do”

Contributing Factors

• Health - Physical & Mental• Poverty• Shame• Social isolation• Abuse• CALD

Workforce

• Knowledge of, or background in, gerontology particularly in relation to medications used by older adults

• Respect for older adults and their place in the community

• Patience and perseverance• Strong boundaries.• Resilience• Qualifications in AOD

treatment• Partnerships

Prevention – Reducing Risky Drinking

• VAAP funded• Prevent late onset issues• Educate about alcohol,

medications and standard drinks

• Alcohol Related Problems Scale (ARPS)

• www.wisedrinking.org

Future• Getting older• Baby boomers are more

demanding of health services

• Likely broader range of drugs

• Likely more health issues associated with ageing and chronic disease

Victorian Alcohol and Drug Association - VAADA

• Easier entry and targeted AOD services for older adults

• 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

Thanks

• St John of God Healthcare• Victorian Government• Australian Drug Foundation• The OWL team

Simon Ruthsruth@phcn.vic.gov.au