Substance Abuse and Misuse in the Elder Population

Introduction
Prior to my entry into the BSW program at California State University, Chico, I had functioned as an Addiction Treatment Specialist. My certification was through the California Association of Alcohol and Drug Educators. While interning with a regional adult services agency, my prior experience facilitated an interest in substance abuse and the older adult population.

Statement of Need
Elders, persons 65 years of age or older, constitute the fastest growing segment of American society. One serious problem faced by this community is that of substance abuse. The abuse of prescription and over the counter medications is an under diagnosed and under treated problem that is viewed as a “silent epidemic” by some (Widlitz & Marin, 2002). Research indicates that up to 20% of geriatric outpatients may suffer from alcohol dependence (Benshoff, Harrawood, & Koch, 2003). The impact of substance abuse among elders may be devastating. This problem may negatively affect all aspects of an elder’s life. It may also place a substantial strain on the financial resources of both elders and the general community.

Kusserow (as cited in Lyder, Fennie, Chen, & Fulmer, 2001) found that the combined use of multiple medications and the adverse effects that sometimes result are annually associated with 32,000 hip fractures, 163,000 cases of mental impairment, and 61,000 cases of Parkinsonism in elders. In addition to the personal pain and suffering experienced by elders and their families because of substance abuse, there is also a substantial societal burden. Widlitz and Marin (2002) state that Medicare was charged $233,543, 500 in 1989 alone for hospital cases in which the primary diagnosis was related to alcohol abuse.

Description of the Intervention
Research indicates that educating the elder population, and social workers involved with them, may mitigate the devastating effects of elder substance abuse. The units of attention in this project included the workers of an adult services agency and its older adult clients. The plan included the production of an information sheet for social workers concerning elder substance abuse. This sheet was to include the CAGE, (CAGE is an acronym composed of the first letters of key word in each question of the assessment tool), which is a short assessment for elder substance abuse (Widlitz & Marin, 2002). An information sheet was to be produced for agency workers to distribute to elder clients as needed. The purpose was to provide information specific to older clients and include possible options available to help them address and recognize substance abuse problems. To avoid the unnecessary expenditure of scarce recourses, this information was to be made available electronically to be accessed and printed as the need arose. The project was to be completed and ready for implementation by April 12, 2005.

The intervention proceeded as planned with one minor alteration. I reviewed the proposed project with three agency workers, including two public health nurses. The workers were given a copy of the literature review paper that I had written during the research phase of the project. After they read the paper, I solicited feedback in an attempt to ascertain what information they considered particularly valuable for inclusion in the workers fact sheet. There was consensus that it was difficult to specify what information was the most valuable for inclusion. It was decided that, instead of a fact sheet, workers would be provided with a copy of the paper. This was a feasible alternative due to the plan to distribute the material electronically through inter-departmental email. If the material required printed distribution, this would not have been a cost effective option. This idea was proposed to my supervisor who agreed to the change.

A fact sheet was written and a copy of the literature review paper and fact sheet were transferred to a disk and given to the appropriate supervisor on April 11, 2005. The supervisor reviewed and approved the fact sheet. She had read and approved the paper several weeks previously. The supervisor then gave the project package, including fact sheet and paper, to the agency program manager for final approval. On April 13, I met with the program manager who suggested some changes to the fact sheet. The required changes were made and she was provided with the revised copy on April 18. On April 25, the program manager approved the final version of the project. I was then instructed to submit the final package to my supervisor who was to present it at the agencies supervisors meeting on April 26. On April 27, my supervisor asked if I would present the project at a supervisory meeting on May 4th. As of this writing, the supervisor plans to distribute the project to agency staff upon receipt of final approval. The scheduled implementation date, April 12, 2005 will probably be extended to the second week of May.

Evaluation of the Intervention
Unfortunately, there has not been sufficient time to assess the effectiveness of this intervention. While the feedback I have received, concerning the quality of the information provided, has been positive, the eventual impact of the project is uncertain. If workers find it useful and it becomes a tool that is utilized regularly, it may help to increase the quality of life of some clients. It would be interesting to evaluate the project after six months to one year in order to answer several questions. For example:

• Did workers find the information useful?
• Did they use it to educate their clients?
• Did workers become more sensitive to the problem of substance abuse in the older population?
• How did the clients receive the information?
• What percentage of the client base, that was offered options for addressing substance abuse issues, took advantage of the information

Reflections on the Project
I have enjoyed working on this project. Substance abuse among the older population has been largely ignored in the treatment field. I was glade to have a part in increasing the awareness of workers concerning this issue. The process allowed me the opportunity to work with several wonderful people and I was energized by their enthusiasm and interest in the subject. I look forward to working on future projects concerning this problem. The education gained in this process should help me in the development of future projects that may have a greater scope and sphere of influence.

References
Benshoff, J.J., Harrawood, L.K., & Koch, D. S. (2003). Substance abuse and the elderly: Unique issues and concerns. Journal of Rehabilitation, 69(2), 43-48.
Lyder, C. H., Fennie, K., Chen, C., & Fulmer, T. (Winter, 2000-2001). Appropriate prescribing for elders: Disease management is not enough. Generations, 55-59.
Widlitz, M., & Marin, D. B. (2002). Substance abuse in older adults: An overview. Geriatrics, 57(12), 29-34.