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Substance Abuse in the Aging

Substance Abuse in the Aging. Tiffany Lorton, UAMS, 2009. Learning Objectives. List key components of assessing older adults for substance abuse Identify nursing interventions for older adults who abuse substances

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Substance Abuse in the Aging

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  1. Substance Abuse in the Aging Tiffany Lorton, UAMS, 2009

  2. Learning Objectives • List key components of assessing older adults for substance abuse • Identify nursing interventions for older adults who abuse substances • Identify s/s of ETOH abuse and withdrawal in older adults and corresponding nursing interventions • Identify s/s prescription, nonpresciption, nicotine, and caffeine abuse in older adults and corresponding nursing interventions

  3. Substance Abuse Among older persons, commonly abused substances are: • ETOH • Prescription and nonprescription drugs • Nicotine • Caffeine

  4. Alcohol Abuse -Alcohol abuse is prevalent in 10% to 15% of older adults -Symptoms may include: • Erratic changes in affect, mood, bx. • Malnutrition • Bladder/bowel incontinence • Gait disturbances • Reoccurring falls/injuries

  5. Alcohol Abuse Approximately 1/3 of older adults begin to abuse ETOH because of: • Bereavement • Retirement • Loneliness • Physical/emotional illness What is the common theme?:

  6. Alcohol Abuse Other symptoms of ETOH abuse: • Anxiety • Nervousness • Blackouts • Confusion • Weight loss • Falls

  7. Alcohol Abuse Physical assessment of intoxication may reveal: • ETOH on breath • Unsteady gait • Nystagmus • Impairment in attention or memory What else?

  8. Alcohol Abuse Prolonged abuse: • Jaundice and ascites • Poor personal hygiene • Poor nutritional status

  9. Alcohol Abuse Screening Tools MAST-G • Modified form of The Michigan Alcoholism Screening Test for geriatric population http://ucsfagrc.org/module_four/pdfs/MAST_G.pdf • More reliable and valid in older population than other instruments

  10. Alcohol Abuse Alcohol Withdrawal • Begins 4-12 hrs. after ETOH intake is stopped/reduced • Elevated BP & HR, autonomic hyperactivity • Goal: Prevent DTs and seizures

  11. Alcohol Abuse Detox • Continual assessments -Clinical Institute Withdrawal Assessment tool-measures the severity of withdrawals based on 10 common s/s -http://www.agingincanada.ca/CIWA.HTM • Low stimulation environment, seizure precautions • Meds- minimize withdrawal symptoms and prevent seizures

  12. Alcohol Abuse Rehab Recommended nursing interventions include: • Education -Relapse prevention • Con’t med administration • Group, individual, and/or family therapy • 12-step program

  13. Alcohol Abuse Evaluation of tx. • Determination of safe detoxification -weaning from ETOH without seizures, DTs, or withdrawal complications • Adherence to a tx. plan for sobriety • Outpatient support • Multidisciplinary approach- treatment options (AA)

  14. Prescription Medications and the Older Adult • Number of meds prescribed is directly correlated to the risk of inadvertent misuse • Polypharmacy -Use or administration of more medications than is clinically indicated -5 of more meds http://www.insidermedicine.ca/Archives/Multiple_Medications_Increases_Risk_of_Error_in_El_213.aspx

  15. Cardiovascular meds * Benzodiazepines Diuretics Cathartics *Benzodiazepine dependence is most common Antacids Thyroidal meds Anticoagulants Prescription MedicationCommonly Used Drugs

  16. Very similar to ETOH May use the MAST-G -substitute prescription meds for ETOH Be aware of repeatedly losing prescriptions/pills “I threw them away by accident” Prescriptions from multiple physicians Congruency b/w the complaint and clinical presentation Above average knowledge about meds S/S withdrawals Prescription MedsAssessment

  17. Assess all meds and develop a safe detox plan Low stimuli environment/seizure precautions Meds to minimize withdrawal Nutritional support Multidisciplinary approach- treatment options (NA, individual/group/family therapy Prescription MedsInterventions

  18. Prescription Meds Evaluation Follow-up is essential • Participation in treatment program • Decreased drug-seeking bx • Pt. education- appropriate med use and effects of misuse

  19. Non Prescription Medications Interventions • Assess clients’ nonprescription med history -Don’t forget natural and herbals • Stress the importance of consulting physician and/or pharmacist before taking nonprescription meds • Evaluate clients’ understanding of the effects of nonprescription meds

  20. Know the name, amt., type, freq., purpose, and side effects of prescription/nonprescription meds Bring all meds to every MD visit Never borrow or share meds Assess client’s ability to self-administer (vision, judgment, memory etc.) Simplify regimen as much as possible Use a single pharmacy Safe Use of Medication

  21. Nicotine • Tobacco use is a risk factor in many of the leading causes of death for older adults • Many >50y/o express the desire to quit; only those with chronic illness tend to have the motivation to do so • Older adults who stop tobacco usage can increase life expectancy

  22. Nicotine Assessment • S/S nicotine withdrawal -Depressed mood, insomnia, irritability, frustration, restlessness, increased appetite • Tobacco use pattern • Fagerstorm Nicotine Tolerance Quiz (Box 18-9) http://www.cancer.org/docroot/PED/content/PED_10_13x_Smoking_Habits_Quiz.asp

  23. Nicotine Interventions • Nicotine Replacement- reduces withdrawal symptoms -nicotine gum -nasal spray - transdermal patches -Nicotrol inhaler- 45% quit rate after 6 wks. • Clonidine Antihypertensive that blocks the neurologic symptoms that produce nicotine withdrawal

  24. Nicotine Postpone/Inhale/Reconsider • B-mod program that decreases tobacco use and helps with stress mgmt. 1.Take a cigarette from a pack, replace, wait 5 minutes. 2. During the 5 min interval place 2 fingers to the mouth as if smoking and inhale slowly. 3. Repeat as necessary. • Clients have reduced smoking by 50% using this technique.

  25. Nicotine Evaluation Assess for: • Decreased tobacco use • Compliance with regimen to quit • Understanding of the effects that tobacco and nicotine have on the body

  26. Caffeine Many symptoms associated with caffeine intoxication can mimic many symptoms including: • Nervousness • Restlessness • Excitement • Insomnia • Diuresis • GI Disturbances • Muscle twitching • Tachycardia, arrhythmias

  27. Product Drip-brewed coffee Instant coffee Decaffeinated coffee Tea Cola Hot Cocoa Chocolate bar Excedrin Anacin Caffeine (mg) 90-140 60-100 2-4 30-100 25-50 5-50 25-35 60 30 Caffeine

  28. Caffeine Assessment • S/S intoxication and withdrawal -Withdrawal- HA, fatigue, depression, anxiety, N&V, muscle pain/stiffness Interventions & Evaluation • Encourage noncaffeinated products • Educate on the effects of meds and caffeine • Document teaching

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