Screening and Assessment for Alcohol in Older Adults Knowledge Exchange Forum CAMH March 15th, 2013

Transcription

1 Screening and Assessment for Alcohol in Older Adults Knowledge Exchange Forum CAMH March 15th, 2013 Marilyn White-Campbell Geriatric Addiction Specialist Community Outreach Programs In Addictions COPA Bonnie Franklin Social worker Alcohol, Drug & Gambling Services Hamilton Public Health Services

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3 WHY DO WE NEED LIFE STAGE SPECIFIC ASSESSMENT TOOLS FOR OLDER ADULTS? IMPORTANT TO ASK THE QUESTION ALCOHOL IS A DRUG BASELINE FUNCTION QUANTITY /FREQUENCY OTHER SUBSTANCES (OTC /Over the Fence)

4 Memory Impairment Alcohol related brain disease affects memory balance mobility Neuro Cognitive decline

5 Substance Use Alcohol Older Adults Additional care is required when applying DSM-IV diagnostic criteria to seniors Seniors can experience significant problems with even low amounts of alcohol intake Tolerance and withdrawal need not be present for there to be a problem

6 Who do we choose to help?

7 Signs of an alcohol or drug problem can be mistaken for Signs of Aging Confusion Depression Disorientation Unsteady gait/falls Recent memory loss Loss of interest in activities Social isolation Tremors Irregular heart rate Poor appetite Stomach complaints

8 Why use geriatric specific tools? More accurate responses Language appropriate to seniors Asks about experiences relevant to seniors Identifies at risk drinkers/ problem drinkers / dependant drinkers Screening and interventions focused on lifestyle factors, including alcohol use, may be the most appropriate way to maximize health outcomes and minimize health care costs among older adults (Barry et al., 2001; Blow, CSAT, 1998b; Wetle, 1997).

9 Low risk drinking guidelines Quality and type of substance in addition to quantity and frequency (including substances not intended to be imbibed). In Canada, a standard drink of alcohol (ethyl alcohol or ethanol) contains 13.6 grams or 17 ml of absolute alcohol - the amount contained in a 12-ounce (341ml) bottle of regular (5%) beer, five ounces (142 ml) of (12%) table wine or 1.5 ounces (43 ml) of 80-proof liquor.

10 What is a standard drink? Red or white wine A12 ounce (341 ml) bottle of beer = 5 ounces (142 ml) of table wine = 1.5 ounces (43 ml) of hard liquor

11 Recommended Drinking Limits for Older Adults - No more than 1 standard drink per day or 7 per week - No more than 2 drinks on any drinking day - Limits for older women should be less than 1 standard drink per day

12 Alcohol Withdrawal and Older Adults Withdrawal takes longer up to two weeks Complicated by medical health May be at increased risk for delirium Increased risk for falls

13 SHORT MICHIGAN ALCOHOL SCREENING TEST GERIATRIC VERSION (SMAST-G) 1. When talking with others, do you ever underestimate how much you actually drink? 2. After a few drinks, have you sometimes not eaten or been able to skip a meal because you don t feel hungry? 3. Does having a few drinks help decrease your shakiness or tremors? 4. Does alcohol sometimes make it hard for you to remember parts of the day or night? 5. Do you usually take a drink to relax or calm your nerves? 6. Do you drink to take your mind off your problems? 7. Have you ever increased your drinking after experiencing a loss in your life? 8. Has a doctor or nurse ever said they were worried or concerned about your drinking? 9. Have you ever made rules to manage your drinking? 10. When you feel lonely, does having a drink help? SCORING 2 or more positive responses is indicative of an alcohol abuse problem (range of scores of 0-10 possible). Contact source: Frederic C. Blow, Ph.D., University of Michigan Alcohol Research Center, 400 E. Eisenhower Parkway, Suite A., Ann Arbor, MI 48104,

14 CAGE Have you ever thought you should CUT DOWN on your drinking? Have you ever felt ANNOYED by others' criticism of your drinking? Have you ever felt GUILTY about your drinking? Do you have a morning EYE OPENER?

15 OTHER TOOLS WHY NOT THE CAGE? COMMONLY USED BY DR S CONFRONTIVE CLIENT MAY NOT TELL THE TRUTH ED STUDY M.White-Campbell, 2007

16 Senior Alcohol Misuse Indicator (SAMI) Tool 1a) Have you recently (in the last few months) experienced problems with any of the following (if yes, please check box): Changes in sleep? Changes in appetite or weight? Drowsiness? Dizziness? Poor balance? Falls? Difficulty remembering things? 1b) Have you recently (in the last few months) experienced problems with any of the following (if yes, please check box): Feelings of sadness? Lack of interest in daily activities? Feelings of worthlessness? Loneliness? Feelings of anxiety? 2. Do you enjoy wine/beer/spirits? Which do you prefer? 3. As your life has changed, how has your use of [selected] wine/beer/spirits changed? 4. Do you find you enjoy [selected] wine/beer/spirits as much as you used to? Yes No 5. You mentioned that you have difficulties with [from answers to questions 1a) and b)]. I am wondering if you think [selected] that wine/beer/spirits might be connected? Yes No

17 Senior Alcohol Misuse Indicator (SAMI) Tool Scoring Key Single responses (A score of 1 for each response): Question #2: I enjoy all of wine/beer spirits I enjoy a combination of two from wine/beer/spirits Question #3: I have increased alcohol consumption from when I was younger Question #5: Yes, there may be a connection between my alcohol use and health SUBTOTAL 1 = /4 Multiple responses (A score of 1 for each combination of responses): Questions #2 & 3: Yes, I do enjoy alcohol There has been no change in alcohol consumption => If both responses provided, check box => Questions #1, 2, 3: Yes, I have experienced 5 or more symptoms Yes, I do enjoy alcohol Indicates any current alcohol consumption (regardless of any change in pattern) => If all three responses provided, check box => SUBTOTAL 2 = /2 TOTAL SCORE = SUBTOTAL 1 + SUBTOTAL 2 = A score of 1 or above would flag the respondent as a possible at-risk or problem drinker.

18 Senior Alcohol Misuse Indicator (SAMI) Screening tool to identify seniors that may have problems with alcohol use Sensitive & non-judgmental to older adult population issues Open- ended questions reflective of info gathered in general assessment Flow of questions helps lead into enquiry of substance use

19 Senior Alcohol Misuse Indicator Helps client make link between health problem and alcohol use Opens door for clinician to ask client about use, and interest in making a change Clinician can provide information/education on role of small amount of alcohol on the body, changes with age when taken in conjunction with medication

20 Geriatric Depression Scale (GDS) It is not uncommon for depression to be present when there is alcohol misuse. Alcohol has a depressant effect on the body. It is important to screen for depression, but beyond this, we need to explore the interactions of alcohol and depression.

21 Geriatric Depression Scale Geriatric Depression Scale (short form) 1 Tools may be copied without permission Instructions: Circle the answer that best describes how you felt over the past week. 1. Are you basically satisfied with your life? yes no 2. Have you dropped many of your activities and interests? yes no 3. Do you feel that your life is empty? yes no 4. Do you often get bored? yes no 5. Are you in good spirits most of the time? yes no 6. Are you afraid that something bad is going to happen to you? yes no 7. Do you feel happy most of the time? yes no 8. Do you often feel helpless? yes no 9. Do you prefer to stay at home, rather than going out and doing things? yes no 10. Do you feel that you have more problems with memory than most? yes no 11. Do you think it is wonderful to be alive now? yes no 12. Do you feel worthless the way you are now? yes no 13. Do you feel full of energy? yes no 14. Do you feel that your situation is hopeless? yes no 15. Do you think that most people are better off than you are? yes no Total Score

22 Scoring of Geriatric Depression Scale More than five is indicative of concern Need for follow-up

23 Montreal Cognitive Assessment (MoCA Provides opportunity to have a baseline of cognitive function, which will influence the treatment plan, and can also be helpful in demonstrating later that things have improved when alcohol or substances are no longer part of the picture. Alcohol induced memory impairment is not necessarily permanent.

24 MOCA MONTREAL COGNITIVE ASSESEMENT

25 Screening Tools Screening tools are to be used as an ADJUNCT to the conversation Screening tools are not meant to REPLACE having the conversation

26 KEY FACTS For older adults, consequences of substance use and withdrawal are often more immediate and intense than in the general adult population. Questions need to be appropriate for the life stage and the context and sequence of questioning are important. Going beyond substance use to assess mental health and cognitive status can provide a context for the information gathered and clarify the treatment plan.

27 Can of Worms A minister decided that a visual demonstration would add emphasis to his Sunday sermon. Four worms were placed into four separate jars. The first worm was put into a container of alcohol. The second worm was put into a container of cigarette smoke. The third worm was put into a container of chocolate syrup. The fourth worm was put into a container of good clean soil.

28 At the conclusion of the sermon the Minister reported the following results: The first worm in alcohol - Dead The second worm in cigarette smoke - Dead Third worm in chocolate syrup - Dead Fourth worm in good clean soil - Alive So the Minister asked the congregation, What can you learn from this demonstration?

29 A little old woman in the back quickly raised her hand and said, "As long as you drink, smoke and eat chocolate, you won't have worms!"

30 QUESTIONS?

31 CONTACT INFORMATION Bonnie Franklin Social worker Alcohol, Drug & Gambling Services Hamilton Public Health Services Tel: ext 3604 Marilyn White-Campbell Geriatric Addiction Specialist Community Outreach Programs In Addictions COPA tel ext

32 Thank you for listening