Psychiatric disorders in the elderly. Psychopharmacologic management

Drug and alcohol referrals: are elderly substance abuse diagnoses and referrals being missed?

OBJECTIVE

To examine the diagnosis of problem substance use in hospital inpatients aged 65 years and over and their referral to drug and alcohol services by medical staff.

DESIGN

Questionnaire to registrars or house officers caring for patients 65 years of age and over with problem substance use.

SETTING

3 hospitals in New South Wales, Australia.

SUBJECTS

Medical staff caring for 263 inpatients.

RESULTS

Medical staff did not recognise substance misuse in older hospital patients and did not seem to be aware of current recommendations of the National Health and Medical Research Council recommendations for safe use of alcohol and benzodiazepines. Three out of 88 problem users of benzodiazepines, 29 out of 76 smokers, and 33 out of 99 problem drinkers were identified by medical staff. Of those identified with problems, 2 benzodiazepine users, 6 smokers, and 19 drinkers were considered for referral to drug and alcohol services.

CONCLUSIONS

Greater awareness of recommendations for dealing with problem use of benzodiazepines and alcohol needs to be promoted among medical staff, along with an increased emphasis in medical education on substance use as a potentially important problem for older people. Drug and alcohol services also need to promote a broader role, particularly in regard to early intervention in a hospital setting for older patients.

Anxiety disorders in the elderly. An update on diagnosis and treatment

Anxiety is a symptom complex with a differential diagnosis that has become increasingly specific in recent years. Elderly patients often present to their primary care physician with symptoms of anxiety rather than seek a mental health professional. Because presentation may be somewhat different in elderly patients than in young adults, careful consideration of the differential diagnosis is important to ensure the most effective treatment. Pharmacotherapy, behavioral therapy, and traditional psychotherapy are useful for these disorders.