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Chapter 16 - Drug and Alcohol Misuse in Older People

Published online by Cambridge University Press:  04 April 2024

By
Tony Rao  and
Cathy Symonds
Edited by
George Tadros  and
George Crowther
George Tadros
Affiliation:
Aston University, Birmingham
George Crowther
Affiliation:
Leeds and York Partnership NHS Foundation Trust, Leeds
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Summary

Alcohol and drug misuse are no longer confined to younger people, as the baby boomer cohort of older people shows the fastest rise in rates of mortality from drugs and from alcohol. This chapter provides an overview of substance misuse in older people, starting with its terminological, epidemiological, and pharmacological aspects. It goes on to detail clinical aspects that include screening, diagnosis, and presentations such as alcohol withdrawal, self-harm, drug intoxication, overdose, drug withdrawal, and psychosis.

Particular attention is paid to age-related syndromes such as alcohol-related brain damage – amnestic syndrome and alcohol-related dementia. The chapter also considers the relevance of comorbid physical disorders that can affect a range of pathologies and dysfunctions, particularly in gastro-intestinal, respiratory, cardiovascular, and neurological systems.

The organisation of care is also discussed, in order to highlight the importance of multi-agency working to provide a range of interventions that include liaison old age psychiatry and hepatology. The chapter goes on to cover medico-legal aspects as well as substance misuse and driving. It concludes with a section on discharge planning, emphasising the role of multidisciplinary teams in harm reduction – as well that of carers, non-statutory organisations, medical, and mental health services.

Keywords

alcoholdrugssubstance misuseolder peopledual diagnosisharm reductionintegrated care
Type
Chapter
Information
Handbook of Old Age Liaison Psychiatry , pp. 233 - 245
Publisher: Cambridge University Press
Print publication year: 2024

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References

Rao, R., and Roche, A. Substance misuse in older people. Brit Med J 2017, 358: j3885.CrossRefGoogle ScholarPubMed
Rao, R. ‘Sadly confused’: The detection of depression and dementia on medical wards. The Psychiatrist 2001, 25: 177–9.Google Scholar
Crome, I., Dar, K., Janikiewicz, S., Rao, T., and Tarbuck, A., 2018. Our Invisible Addicts: Second Report of the Older Persons’ Substance Misuse Working Group of the Royal College of Psychiatrists (CR211). London: Royal College of Psychiatrists, 2018.Google Scholar
Royal College of Psychiatrists. Substance Misuse in Older People: An Information Guide. Cross Faculty Report FR/OA/A)/01. London: Royal College of Psychiatrists, 2015.Google Scholar
World Health Organization. The Tenth Revision of the International Classification of Diseases and Related Health Problems (ICD–10). Geneva: WHO, 1992.Google Scholar
Blow, F.C., Gillespie, B.W. et al. Brief screening for alcohol problems in elderly populations using the Short Michigan Alcoholism Screening Test–Geriatric Version (SMAST-G). Alcoholism: Clinical and Experimental Research (Suppl.) 1998, 16: 372.Google Scholar
Nayional Institute of Clinical Excellence. Falls in Older People: Assessing Risk and prevention. Clinical Guideline (CG161). London: NICE, 2013.Google Scholar
Adinoff, B., Bone, G.H., Linnoila, M. Acute ethanol poisoning and the ethanol withdrawal syndrome: Medical toxicology. Adverse Drug Exp 1988, 3: 172–96.CrossRefGoogle Scholar
Pompei, P., Foreman, M., Rudberg, M.A., Inouye, S.K., Braund, V., and Cassel, C.K. Delirium in hospitalized older persons: Outcomes and predictors. J Am Geriatrc Soc 1994, 42: 809–15.Google Scholar
Roffman, J.L., and Stern, T.A. Alcohol withdrawal in the setting of elevated blood alcohol levels. Primary Care Companion to the Journal of Clinical Psychiatry 2006, 8: 170–3.Google ScholarPubMed
Sullivan, J.T., Sykora, K., Schneiderman, J., Naranjo, C.A., and Sellers, E.M. Assessment of alcohol withdrawal: The revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict 1989, 84: 1353–7.CrossRefGoogle ScholarPubMed
Ness, J., Hawton, K., Bergen, H., Cooper, J., Steeg, S., Kapur, N., Clarke, M., and Waters, K. Alcohol use and misuse, self-harm and subsequent mortality: An epidemiological and longitudinal study from the multicentre study of self-harm in England. Emerg Med J 2015, 32: 793–9.CrossRefGoogle ScholarPubMed
El-Sohly, M.A., Mehmedic, Z., Foster, S., Gon, C., Chandra, S., and Church, J.C. Changes in cannabis potency over the last 2 decades (1995–2014): Analysis of current data in the United States. Biological Psychiatry 2016, 7: 1–7.CrossRefGoogle Scholar
Fahmy, V., Hatch, S.L., Hotopf, M., and Stewart, R. Prevalences of illicit drug use in people aged 50 years and over from two surveys. Age and Ageing 2012, 41: 553–6.CrossRefGoogle ScholarPubMed
Pétursson, H. The benzodiazepine withdrawal syndrome. Addiction 1994, 89: 1455–9.CrossRefGoogle ScholarPubMed
Tompkins, D.A., Bigelow, G.E., Harrison, J.A., Johnson, R.E., Fudala, P.J., and Strain, E.C. Concurrent validation of the Clinical Opiate Withdrawal Scale (COWS) and single-item indices against the Clinical Institute Narcotic Assessment (CINA) Opioid Withdrawal Instrument. Drug Alcohol Depend 2009, 105: 154–9.CrossRefGoogle ScholarPubMed
Oslin, D., Atkinson, R.M., Smith, D.M., and Hendrie, H. Alcohol-related dementia: Proposed clinical criteria. Int J Geriatr Psychiat 1998, 13: 203–12.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
Ridley, N.J., Draper, B., and Withall, A. Alcohol-related dementia: An update of the evidence. Alzheimers Res Ther 2013, 5: 3.CrossRefGoogle ScholarPubMed
Gazdzinski, S., Durazzo, T.C., Studholme, C., Song, E., Banys, P., and Meyerhoff, D.J. Quantitative brain MRI in alcohol dependence: Preliminary evidence for effects of concurrent chronic cigarette smoking on regional brain volumes. Alcohol Clin Exp Res 2005, 29: 1484–95.CrossRefGoogle ScholarPubMed
Rao, R. Cognitive impairment in older people with alcohol use disorders in a UK community mental health service. Adv Dual Diag 2016, 9: 154–8.Google Scholar
National Confidential Enquiry into Patient Outcome and Death. Measuring The Units: A Review of Patients Who Died with Alcohol-Related Liver Disease. London: NCEPOD, 2013.Google Scholar
World Health Organization. Global Status Report on Road Safety, 2015. Geneva: World Health Organization, 2015.Google Scholar
Department of Transport. Reported Drinking and Driving (RAS51). London: Department of Transport, 2018.Google Scholar
Clarke, D.D., Ward, P., Bartle, C., and Truman, W. Older drivers’ road traffic crashes in the UK. Accident An Prev 2010, 42(4): 1018–24.Google ScholarPubMed
Drug or Alcohol Misuse or Dependence: Assessing Fitness to Drive: Advice for Medical Professionals to Follow When Assessing Drivers with Drug or Alcohol Misuse or Dependence. London: Department of Transport, 2018.Google Scholar

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