Treatment Options for Older Adults with Substance-Use Disorders

Transcription

1 Oxford Medicine Online You are looking at 1-10 of 75 items for: cancer and treatment MED00840 Geriatric Psychiatry and the Management of Chronic Pain Jordan F. Karp and Mark D. Miller ISBN: eisbn: DOI: /med/ This chapter reviews the basic anatomy and physiology of pain, and describes how advancing age affects the pain experience. This chapter also focuses on reciprocal relationships among pain, depression, anxiety, sleep; the assessment of pain in cognitively impaired patients; and psychiatric approach to older adults living with chronic pain. Alcohol and Older Adults Anna Terajewicz LaRose and John Renner DOI: /med/ This chapter reviews the prevalence, health risks, and treatment of alcohol use in older adults. We consider epidemiological data showing that a significant proportion of older adults who use alcohol exhibit harmful drinking behavior. We explore the recommendations for alcohol use and definitions of unhealthy use, the neurobiology of alcohol addiction, cognitive effects of alcohol use, and medical sequelae of chronic alcohol use. We identify biomarkers, effective screening tools, and brief interventions for hazardous and harmful alcohol use in older adults. Possible benefits for light alcohol use, as well as risks and medical complications of alcohol use among older adults, are considered. Finally, we review the medical treatment of intoxication and alcohol-use disorders in this population, with an emphasis on the need for evidence-based research to guide clinical practices in identifying harmful levels of use and developing treatment strategies for older patients with alcohol use disorders. Treatment Options for Older Adults with Substance-Use Disorders Stacy A. Cohen, Margaret M. Haglund, and Larissa J. Mooney DOI: /med/ Page 1 of 5

2 Due to co-occurring medical disorders, psychosocial differences, functional and cognitive limitations related to aging, and the potential for multiple medication interactions, unique considerations must be made when addressing the diagnosis and treatment of SUDs among the elderly. Better information is needed on all fronts, from initial screening and assessment, to triaging to appropriate levels of care, to behavioral therapies and pharmacological treatment. Guidelines should help direct providers, families, and patients identify appropriate and individualized treatment programs. Encouragingly, outcomes appear to be as good, if not better, in the older population than in younger adults treated for SUDs. As the baby boomer population ages, more older adults will need treatment for illicit drug use, alcoholism, and the misuse of prescription medications. Greater education and awareness of this growing problem will increase attention paid by clinicians and policymakers allocating resources to address the treatment of SUDs in the older population. Abuse of Opioids and Prescription Medications Isis Burgos-Chapman, Louis A. Trevisan, and Kevin Sevarino DOI: /med/ This chapter reviews an under-recognized aspect of geriatrics. The elderly population is growing in number, as is the proportion of aging baby-boomers at high risk for pain medication misuse and opioid use disorders. Given the widespread use of opioids in pain management, one can expect that problems with opioid use will increase among the elderly in the coming years. We describe the magnitude of the problem and discuss the importance of risk-stratification to identify which older patients are at elevated risk to develop problems with opioids. We examine the role of opioids in chronic pain treatment and the pitfalls of their use in the elderly. Finally, we provide general guidelines for the treatment of pain medication misuse and/or an opioid use disorder in the elderly. Opioid medication misuse and use disorders should be on every practitioner s radar as a possible reason for problems surfacing in the elderly patient. Mood disorders Terry Robinson and Jane E. Scullion Print Publication Year: 2009 Published Online: Oct 2011 ISBN: eisbn: DOI: /med/ Mood disorders an overview - Diagnosing depression - Depression epidemiology - Special presentations of depression in older people: 1, Pseudodementia - Special presentations of depression in older people: 2, Hypochondriasis - Special presentations of depression in older people: 3, Severe retardation - Suicide in older people - Managing an older person after an overdose - Aetiology of depression in older people: 1, Biological factors - Aetiology of depression in older people: 2, Psychological and social factors - Management of depression among older people drug treatment - Drug treatment of Page 2 of 5

3 depression alternatives to SSRIs - Drug treatment second line - ECT - Psychological treatment of depression - Managing the recently bereaved - Managing depression in frail older people - Depression rating scales - GDS-15 - Mania and bipolar illness - Managing mania and bipolar illness - Drugs for mania Late-Life Depression: Evidence-Based Treatment Mark D. Miller, Charles F. Reynolds, Ariel Gildengers, Ellen M. Whyte, and Carmen Andreescu ISBN: eisbn: DOI: /med/ Chapter 9 discusses how late-life depression increases the disability associated with medical comorbidity, worsens the perception of pain intensity, increases caregiver burden and is the greater risk factor for suicide, and reviews the evidence base for effective somatic treatments for late life depression, with emphasis on managing the high recurrence rates, as well as the subtypes of depression, including treatment resistant depression (TRD), vascular depression, Bipolar disorder, depression with psychosis, and depression comorbid with cognitive impairment. Depression in Older Adults Receiving Hospice Care Abhilash K. Desai, Daphne Lo, and George T. Grossberg ISBN: eisbn: DOI: /med/ Depression (both major and minor) is prevalent in terminally ill older adults and is underdiagnosed and undertreated in this population. Depression in older adults receiving hospice care has not been rigorously studied, and most of the existing research in this area has been conducted in patients terminally ill due to cancer. Only a few of these studies involve older adults receiving hospice care. Depression in terminally ill older adults may reduce the quality of life, increase stress in family members, impair decision-making capacity and may shorten survival. Depression is often mistaken for normal grief; although differentiating between them is challenging, a systematic assessment allows for accurate diagnosis. Clinical experience and limited research data indicate that depression responds to a combination of psychosocial and psychopharmacological interventions in older adults who are terminally ill. Conclusion Maria A. Sullivan DOI: /med/ Page 3 of 5

4 Addiction in older adults very often goes unrecognized, for several reasons: social biases about the elderly, age-related metabolic changes, and the inappropriate use of prescription benzodiazepines and opioids to address untreated anxiety and mood conditions. Alcohol or substance-use disorders (SUDs) in older individuals may present in subtle and atypical ways. Strategies to overcome such difficulties include systematic screening using validated instruments, patient education regarding the impact of psychoactive substances on health, and cautious prescribing practices. Relying on standard DSM criteria may result in a failure to detect an SUD that presents with cognitive symptoms or physical injury, as well as the absence of work or social consequences. Older individuals can benefit from the application of risk-stratification measures, and they can be referred, e.g., to age-appropriate group therapy and non-confrontational individual therapy focusing on late-life issues of loss and sources of social support, as well as be offered medication management for alcohol or substance use disorder. Although research has been limited in this population, treatment outcomes have been found to be superior in older adults than younger adults. Overview of Dementia Care Peter V. Rabins, Constantine G. Lyketsos, and Cynthia D. Steele Print Publication Year: 2006 Published Online: Jun 2013 ISBN: eisbn: DOI: /med/ Chapter 5 discusses how the care of patients with dementia is based on six general principles, and how each of these rests on the belief that knowledge of the patient's wishes and goals prior to the illness should guide care. This is easy in the abstract but can be difficult when problems are persistent or severe. It is also easy to lose sight of the fact that small changes can be of great value and provide meaningful improvement in patients' quality of life, as well as that of their caregivers. Cannabis, Nicotine, and Stimulant Abuse in Older Adults Christina A. Brezing and Frances R. Levin DOI: /med/ In conjunction with alcohol, cannabis, nicotine, and stimulants are the substances most commonly used by older adults. Little is known about the specific characteristics of older adults who use these substances and how best to screen, identify, and treat these disorders in this population. As we reach the population peak for aging baby boomers, increasing percentages of older adults are using these substances, and developing substance-use disorders is anticipated. Concomitant factors are policy and social changes toward drugs of abuse in the United States. Evidence presented in this chapter represents what is currently known about cannabis, nicotine, and stimulant use and its impact on older adults. However, the use of these substances in older adults is under-studied, and much of the current information is extrapolated from studies of younger and middle-aged adults. This practice Page 4 of 5

5 represents a large gap in our understanding and a significant opportunity for future research endeavors. Page 5 of 5