Search results

This study aims to review the presentation of substance use disorders in older adults, how addiction intertwines with neurocognitive disorders and how to approach this vulnerable population.

Electronic data searches of PubMed, Medline and the Cochrane Library (years 2000–2021) were performed using the keywords “neurocognitive,” “dementia,” “substance use,” “addiction,” “older adults” and “elderly.” The authors, in consensus, selected pivotal studies and conducted a narrative synthesis of the findings.

Research about substance use disorders in older adults is limited, especially in those with superimposed neurocognitive disorders. Having dual diagnoses can make the identification and treatment of either condition challenging. Management should use a holistic multidisciplinary approach that involves medical professionals and caregivers.

This review highlights some of the intertwining aspects between substance use disorders and neurocognitive disorders in older adults. It provides a comprehensive summary of the available evidence on treatment in this population.

Despite older adult community mental health team (CMHT) workers inevitably encountering service users with alcohol use disorders (AUDs), they have a limited evidence base for working with this group. This paper aims to argue against a wholesale transfer of knowledge and practices from working age adults with dual diagnosis to the older age group.

The paper aims to address the scant attention given to the needs of older service users with a dual diagnosis by detailing the progress of four older adult service users with AUDs in a CMHT.

This case study series illuminates some of the clinical and professional dilemmas and challenges encountered when working with this group. Suggestions of how to respond to some of these challenges are provided by focussing on aspects of identification, assessment and treatment.

This paper provides a catalyst to further discussion, debate and publications on the issue of older people misusing alcohol by presenting and reflecting on the issues raised by four practice vignettes.

This article presents a review of the literature on alcohol and older people, noting that this subject has received very little research attention. In this short review, we offer a synopsis of the physical changes and health problems caused by alcohol use among older people. We then present a typology of drinking in later life, before discussing the findings and shortcomings of recent research knowledge. Reference is also made to the implications for alcohol policy, and solutions around training, health promotion and education are discussed.

Substance use disorders are considered to be the nation's number one health problem. These continue to cause more deaths, illnesses, and disabilities than do other preventable health problems, providing ample support for the need for developing health professional competence in this area. This paper describes the specific steps used by The University of Texas‐Houston Health Science Center School of Nursing to infuse substance abuse content into the undergraduate curriculum, design a graduate subspecialty in addictions nursing, and offer continuing education on substance use disorders to nurses in acute care and community settings. The paper provides guidelines for other academic institutions engaged in the important task of increasing nursing competence related to substance use disorders.

The aim was to determine the number of referrals of people aged 55 and over to three forensic and psychiatric intensive care unit (PICU) services in Scotland, and to describe their demographic, criminological and psychiatric characteristics. Of a total of 1838 referrals, 63 (3.4%) were aged 55 and over. Of these, 35 were referred for court reports or prison assessment and half had been charged with violent or sexual offences. Most were diagnosed as suffering from a psychiatric disorder at the time of assessment, 11 (31.4%) were admitted for further assessment. There were a further 28 admissions to PICU beds. Older adults form a small but important minority of referrals to forensic and PICU services. A single case register would aid further study in this area. Further exploration of the clinical needs of these patients would be useful.

Suicide behaviour rates vary significantly between countries due to a range of cultural, behavioural and health‐related factors. Gender and age‐related factors also appear to be impor tant key determinants of vulnerability to suicide ideation and suicide completion. The homeless population is par ticularly at risk, due to multiple complex issues that relate to social exclusion, alcohol, drug, mental health and nutritional issues. Studying homeless people is problematic due to access, the transitory nature of their contact with statutary services, problems of self‐repor t and recall in people ‐ some of whom have mental health and cognitive issues. There is an increasing interest from practitioners and academic researchers in spiritual factors that appear to modulate the responses of an individual to the internal and external threats that underlie the motivation to end his or her life. Effective approaches to suicide prevention and crisis management require a good understanding of the interplay between this complex set of biological, psychological and social domains. These will be explored in the final section of this review. This paper, therefore, aims to provide a non‐systematic review of the existing literature published in academic journals and relvant ‘grey literature’ and focuses on themes in the literature that will hopefully inform both policy and practice.

Elder mistreatment is a widespread medical and social problem that is often under‐recognised by primary care physicians. The primary aim of this study was to estimate the prevalence of elder mistreatment among elderly patients with mental disorders in Bosnia and Herzegovina. One‐hundred‐and‐eighty‐four patients with different mental disorders were asked to complete the EAST questionnaire as part of a comprehensive geriatric assessment. Screening results were evaluated, and patients who had responses associated with ‘mistreatment’ were invited back to the clinics for additional clinical evaluation. Different types of mistreatment were identified in 71% of all patients. This led to a conclusion that screening for elder mistreatment should be a part of the routine health assessment for all older persons and a part of comprehensive geriatric assessment.

The purpose of this paper is to examine the prescribed psychotropic medications taken by newly referred people with a range of substance use disorders (SUD) who attend a specialist community addiction service.

Anonymised data on newly referred people (n=1,537) with SUD attending a specialist community addiction service for their first episode of treatment between August 2007 and July 2010 were obtained from the database of the service. Data were cleaned and the percentage of people taking prescribed psychotropic medications at their first episode of treatment was calculated.

More than half (56.1 percent) of people attending the service were taking prescribed antidepressants and anxiolytics at their first episode of treatment whilst 15.2 percent of people were taking prescribed antipsychotics. Alcohol and opioids were the primary referral substances for 77.4 percent and 15.2 percent of people respectively. People referred for “other” substances (cannabis, stimulants, sedatives, hallucinogens, solvents and polydrug use) made up the remaining 7.5 percent and had the highest percentage of prescribed psychotropics (antipsychotics=47 percent, antidepressants and anxiolytics=64.3 percent) compared to those referred for alcohol and opioids (p<0.0005).

To the best of the authors’ knowledge, this is the first study of psychotropic prescribing among people with a range of SUD in the UK. The high prevalence of psychotropic prescribing raises questions about the appropriateness of these prescriptions and calls for scrutiny of prescribing practice in this group of people.

The purpose of this paper is to examine an audit that was performed of all patients referred to a liaison psychiatry inpatient consultation service which sought to establish a baseline for demographics, type of referral, and management of referrals, with a view to introducing improved evidence‐based treatments. It also aims to examine timeliness of response to referrals benchmarked against published standards.

All inpatient referrals to a liaison psychiatry service were recorded over a six‐month period, including demographics, diagnosis, management and timeliness of response to referrals. The data were retrospectively analysed and compared against international standards.

A total of 172 referrals were received in the six months. Commonest referral reasons included assessments regarding depressive disorders (23.8 per cent), delirium/other cognitive disorders (19.2 per cent), alcohol‐related disorders (18.6 per cent), anxiety disorders (14.5 per cent), and risk management (12.2 per cent). Evidence‐based practices were not utilised effectively for a number of different types of presentations. A total of 40.1 per cent of referrals were seen on the same day, 75.4 per cent by the end of the next day, and 93.4 per cent by the end of the following day.

Use of a hospital protocol for management of delirium may improve outcomes for these patients. Evidence‐based techniques, such as brief intervention therapies, may be beneficial for referrals involving alcohol dependence. Referrals were seen reasonably quickly, but there is room for improvement when compared with published standards.

This paper provides valuable information for those involved in management of liaison psychiatry consultation services, providing ideas for development and implementation of evidence based practices.