Nonalcohol-related use disorders in geropsychiatric patients

Development of the Older Adult Prescription Drug Assessment Questionnaire for Case Workers

Instruments assessing geriatric case managers’ perceptions of prescription abuse are limited. Based on a review of current literature and pilot testing feedback, 22 items were initially assembled to form an older adult Prescription Drug Assessment Questionnaire (PDAQ). Case managers ( N = 161) at an older adult agency located in a Midwestern state were surveyed using the instrument. Data were subjected to exploratory factor analysis using principal axis factoring (PAF) and Promax rotation, and Horn’s parallel analysis determined the number of extracted factors. PAF generated a final 11-item three-factor model accounting for 51% of total variance explained: Standard Assessment (Factor 1; four items; ∞ = .83), Assessment Belief (Factor 2; three items; ∞ = .74), and Problem Scope (Factor 3; four items; ∞ = .62). The older adult PDAQ is a brief, data-driven instrument with acceptable psychometric properties for assessing perceptions of prescription drug abuse and misuse assessment and counseling.

Prevalence of Mental Health Disorders in Elderly U.S. Military Veterans: A Meta-Analysis and Systematic Review

OBJECTIVE

Older veterans may be vulnerable to mental health problems. Meta-analytic and systematic review methods sought to determine the prevalence rate of mental health disorders in older military veterans (≥65 years).

METHODS

Eleven studies were eligible, and meta-analyses of veteran depression, substance abuse, post-traumatic stress disorder (PTSD), anxiety, dementia, bipolar disorder, and schizophrenia were conducted.

RESULTS

Although conducted exclusively with U.S. veterans, high prevalence rates of substance (5.7%) and alcohol use disorders (5.4%) in older veterans were found. However, the prevalence of other mental health disorders, including PTSD and depression, in older veterans was not markedly high.

CONCLUSION

The rates of disorder prevalence observed indicates a need for continued awareness of mental health difficulties, particularly substance and alcohol use disorders, in older veterans. In the future studies with non-U.S. military samples using a longitudinal design are required to further understand the prevalence of mental health disorders in geriatric veterans.

Primary care providers' perspectives on psychoactive medication disorders in older adults

BACKGROUND

Compared with younger adults, older adults consume a disproportionate percentage of pain and sleep medications. Some studies have reported that psychoactive medication misuse and abuse in older populations is a significant problem.

OBJECTIVES

The aim of this study was to understand the perspective of primary care providers (PCPs) regarding the extent and clinical presentations of misuse and abuse of psychoactive medications in older patients and to explore PCPs' perceived barriers to identifying affected individuals.

METHODS

Seventeen physicians and 5 nurse practitioners from 2 ambulatory care practices serving older adults in New York City participated in this study. Six focus group discussions were audiotaped and transcribed. Two raters coded transcripts to identify recurring themes. Qualitative analysis software was employed for data coding and sorting purposes.

RESULTS

Although PCPs indicated that only a small percentage of older patients were actively misusing or abusing their psychoactive medications (average estimate given by providers, 8%), they felt that these patients placed significant time burdens on them. Perceived risk factors included psychiatric disorders, previous substance abuse history, and cognitive impairment, but many PCPs found it impossible to predict which patients were at increased risk. PCPs identified multiple barriers to identifying affected patients, including lack of communication (between provider and patient, provider and patients' caregivers, and between different providers), nonspecific symptoms, and the lack of a clear definition of misuse and abuse.

CONCLUSIONS

The lack of a clear definition, absence of well-defined risk factors, and ambiguous clinical manifestations of psychoactive medication misuse and abuse present substantial barriers to diagnosis. A standard, age-appropriate definition could help PCPs establish a diagnosis, clarify what constitutes appropriate psychoactive medication use, define the extent of the problem, and pave the way for the development of effective screening and diagnostic tools.

Psychoactive drug abuse in older adults

BACKGROUND

Misuse and abuse of legal and illegal drugs constitute a growing problem among older adults.

OBJECTIVE

This article reviews the prevalence, risks and protective factors, and screening and diagnosis of drug abuse in older adults. Treatment concerns and the consequences of drug problems are examined briefly.

METHODS

MEDLINE and PsychInfo were searched using the terms substance-related disorders, drug-use disorders, abuse, dependency, opioid-related disorders, stimulant-related disorders, cocaine-related disorders, marijuana-related disorders, and withdrawal syndrome. The review included articles published in English between January 1, 1990, and May 31, 2006.

RESULTS

Despite a wealth of information on the epidemiology and treatment of alcohol abuse in older adults, few comparable data are available on drug abuse in this population. The evidence suggests that although illegal drug use is relatively rare among older adults compared with younger adults and adolescents, there is a growing problem of the misuse and abuse of prescription drugs with abuse potential. It is estimated that up to 11% of older women misuse prescription drugs and that nonmedical use of prescription drugs among all adults aged > or =50 years will increase to 2.7 million by the year 2020. Factors associated with drug abuse in older adults include female sex, social isolation, history of a substance-use or mental health disorder, and medical exposure to prescription drugs with abuse potential. No validated screening or assessment instruments are available for identifying or diagnosing drug abuse in the older population. Special approaches may be necessary when treating substance-use disorders in older adults with multiple comorbidities and/or functional impairment, and the least intensive approaches should be considered first.

CONCLUSIONS

Psychoactive medications with abuse potential are used by at least 1 in 4 older adults, and such use is likely to grow as the population ages. The treatment of disorders of prescription drug use in older adults may involve family and caretakers, and should take into account the unique physical, emotional, and cognitive factors of aging. Further research is needed on the epidemiologic, health services, and treatment aspects of drug abuse in older adults, as well as the development of appropriate screening and diagnostic tools.

Utilization of emergency center services by older adults with a psychiatric diagnosis

Information regarding older adult emergency center (EC) patient characteristics remains limited, despite its increasing importance in health care delivery systems. This retrospective study encompasses all EC visits over an eight-year period (n = 825,682) to a large urban county hospital. Only participants with a primary psychiatric diagnosis were examined, and included a total of 53,894 adults, 18-64 years old and 1,478 adults, > or =65 years old. Despite an increasing aging population, EC visits for older adults with psychiatric disorders did not increase over time. Within the older adult sample, cognitive, psychotic, and bipolar disorders were associated with higher rates of admission to the hospital, while substance use, depressive, and anxiety disorders were associated with lower numbers of inpatient admissions. African-Americans were over-represented in the EC and admitted to the hospital at higher rates, compared to other ethnic groups. Caucasian patients were the group most frequently diagnosed with a substance use disorder. In conclusion, differences in race, and diagnosis support the idea that such variables directly relate to utilization rates, presentation, and disposition within the EC.