COMMUNITY OUTREACH PROGRAMS IN ADDICTIONS Elizabeth Birchall NICE Conference 2012

1. COMMUNITY OUTREACH PROGRAMS IN ADDICTIONS Elizabeth Birchall NICE Conference 2012

2. Overview • Older Adults and Addictions • Best and Promising Practices • Access to Treatment • Specialized Geriatric Addictions Services • Knowledge Transfer & Exchange • Resources

3. Older Adults and Addictions

4. Demographics • Canada’s population is aging, and the proportion of those aged 65 years and older has almost doubled in the last fifty years • Population projections indicate that by 2036 almost a quarter (24.5%) of the Canadian population will be 65 years or older (Statistics Canada, 2007) • The baby boomer generation, represent nearly one out of three Canadians, the largest age cohort in Canada and the oldest baby boomers are now entering their retirement years (Statistics Canada, 2007)

5. Older Adults and Substance Use • Many older adults begin to have problems with their substance use during times of transition or loss (e.g. forced retirement, bereavement, new or escalating health concerns, loss of independence) • Their relationship to the substance is based on an emotional need to feel better or deal with loss • Some older adults cannot access and/or do not feel comfortable in mainstream addictions services • Problems with substance use are often not recognized by health and community service providers so help is not offered • The older generation is more likely to experience self stigmatization which reduces the chance of seeking treatment and service

6. Health and Aging • Older adults often have complex and/or chronic health conditions that require they take prescribed medications that can interact with each other and with non prescribed substances (e.g. alcohol, marijuana) • Older adults metabolize substances in a different way • Psychosocial factors such as boredom, loneliness and homelessness are linked to higher alcohol use (Royal College of Psychiatrists, 2011) • Anecdotal clinical experience is that elderly have more prolonged and severe withdrawal than younger patients, and are more likely to develop complications such as delirium • It is not uncommon to find that older people with chronic substance misuse have had multiple head injuries resulting in symptoms of acquired brain injury that is affecting their reasoning and decision making capabilities. • Older adults with some degree of cognitive impairment and/or functional losses are often misdiagnosed with dementia when in fact there may be a substance misuse or addictions issue.

7. Best and Promising Practices

8. Best and Promising Practices • Research shows older adults are as successful in addiction treatment as their younger counterparts. • Health Canada (2002) states best practices identified through research demonstrates that treatment of high need older adults include: • a harm reduction and holistic problem solving approach, • home visiting known as “outreach”, • intensive case management and • social and recreational programs • Clinical experts have added to these principles the need to educate and support those who form the “circle of care” for the older person

9. Goals in an older adult specific approach • The end goal of abstinence is not necessary or realistic instead a harm reduction goal that is related to quality of life improvement as defined by the older person is the aim • Treatment/counseling should be focused on what can make life better, more comfortable and happier, not only on the substance use

10. Access to Treatment

11. Access to Substance Use Treatment • Many older adults are successfully accessing and participating in treatment through mainstream programs. • There is a smaller sub group of the older adult population that require a specialized approach because they are unable to access or participate in mainstream programs.

12. Specialized Geriatric Addictions Services

13. Older Adults and Specialized Addictions Services: Inability to access services: • Mobility issues that require outreach services • Some older adults do not feel their issues are adequately addressed (e.g., aging, loss of independence) • Cognitive impairment related to neurological conditions (e.g., dementia, acquired brain injuries, organic brain disease, or Korsakoff ’s syndrome)

14. Knowledge Transfer & Exchange

15. Mental Health, Addictions and Behavioural Issues Community of Practice • A collaboration between AKE, Seniors Health Research Transfer Network (SHRTN) and Ontario Research Coalition of Research Institutes / Centres on Health & Aging (ORC) to bring together people, ideas, and resources to increase awareness of the needs of seniors affected by serious mental illness, addiction, dementia or behavioural issues. • With the support of this CoPwe formed a Geriatric Addictions Subgroup to work specifically in the area of specialized geriatric addictions.

16. Geriatric Addictions Subgroup Objectives • Promote evidence based/informed practice for specialized addictions treatment and service for older persons to community agencies, researchers and policy makers. • Facilitate knowledge transfer between the addiction sector and the larger seniors’ health, mental health and social service system. • Raise awareness of the issues related to addictions treatment for older persons to ensure inclusion in service delivery planning, policy discussions and initiatives. Deliverables: • A series of Fact Sheets, the first of which is Introduction to Older Adults and Substance Use: Fact Sheet #1 • The Fact Sheets are being adapted by NICE as pocket guides, Fact Sheet #1 will be available shortly • A survey across Ontario regarding older adults and addictions

17. The Survey • In 2011 the Geriatric Addictions Subgroup of the CoP developed and administered a provincial survey of community mental health and addictions agencies regarding older adults and addictions. • This is a preliminary survey to begin to understand how many providers were working with older adults with substance use issues and what the providers see as areas for attention. • The survey was distributed through a number of networks, some of which are not geriatric specific • There were 163 respondents from across the province

18. Survey – Service Need

19. Survey Respondents

20. Location of Respondents

21. The Survey Results • Nearly 96% of the survey respondents are working with older adults with substance misuse issues • Both geriatric and non geriatric tools for screening are being used, with the geriatric tools including those that assess cognitive functioning levels. • Nearly 68% reported they had had some sort of addictions training and identified highest ranked training needs as: • alcohol and dementia, harm reduction, assessment/screening for substance use, and responsive behaviours • Most common interventions/services are: • harm reduction, cognitive behavioural therapy, motivational interviewing, and counselling • psychiatric referral, concurrent disorders programs, abstinence based programs, and withdrawal management(detox) • Most common referrals/consultation used: • extensive use of pyschogeriatric resources and psychiatry • extensive use of unspecified addictions services and the specialized geriatric addictions services (e.g. PAARC, LESA and COPA)

22. Resources

23. Resources • Alzheimers Knowledge Exchange Web site, Specialized Geriatric Information and Approaches: http://www.akeresourcecentre.org/Addictions

24. Contact Information SHRTN/AKE/ORC Community of Practice for Mental Health, Addictions and Behavioural Issues: http://www.akeresourcecentre.org/MentalHealth Community Outreach Programs in Addictions (COPA) Ste 200, 49 Bathurst St., Toronto, ON, M5V 2P2 416-516-2982 www.copacommunity.ca

25. Appendix A: Geriatric Addictions Subgroup Membership • Elizabeth Birchall, Community Outreach Programs in Addictions (COPA) • Julia Baxter, St. Joseph’s Healthcare Hamilton – Halton Geriatric Mental Health and Addiction Outreach & Halton ADAPT • Jan Haycock, Sister Margaret Smith Centre, St. Joseph's Care Group • Carolyn Thompson, Peel Addictions Assessment and Referral Centre (PAARC), Mississauga • Dallas Smith, Lifestyle Enrichment for Senior Adults (LESA) Centretown Community Health Centre Carolyn Thompson, Peel Addiction Assessment and Referral Centre (PAARC) • Bonnie Franklin, Hamilton Public Health Services, Alcohol, Drug and Gambling Services, Older Wiser Lifestyles (OWL) • Robin Hurst, Seniors & Mental Health, Saint Elizabeth Health Care • Tania Solomos , Knowledge Broker, Alzheimer's Knowledge Exchange (AKE)