logging in or signing up Module 10 C Older Adults Haggrid Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 366 Category: Entertainment License: All Rights Reserved Like it (0) Dislike it (0) Added: August 07, 2007 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... By: zinthaq (37 month(s) ago) Interventions are either direct, typically involving a confrontative meeting with the alcohol or other drug dependent person (the most typical type of intervention) or indirect, involving work with a co-dependent family to encourage them to be more effective in helping the addicted individual [url="http://www.drug-intervention.com/missouri-drug-intervention.html"]Drug Intervention Missouri[/url] Saving..... Post Reply Close Saving..... Edit Comment Close By: misba (41 month(s) ago) hat ethical issues are likely to arise in the course of assessment/diagnosis related to alcohol use problems? --------------------- Misbah [url=http://www.drug-intervention.com/id aho-drug-intervention.html]Drug Intervention Idaho[/url] Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Older Adults and Alcohol Problems: Older Adults and Alcohol Problems NIAAA Social Work Education Module 10C (revised 3/04) Outline: Outline Prevalence Drinking guidelines Issues unique to older adults Co-morbid medical and psychiatric conditions Screening and detection Prevention, brief alcohol intervention and treatment Summary and recommendations Prevalence…: Prevalence… Depends on definition of at-risk or problem drinking: 1-15% of older adults are at-risk or problem drinkers Differs with sampling approach Alcohol use problems are the most common substance issues for older adults. Confounded by prescription, herbal, and over-the-counter medications Prevalence (continued): Prevalence (continued) Older adults with alcohol use problems are not recognized by many professionals Few older adults with alcohol abuse or dependence seek help in specialized addiction treatment settings ©2002 Microsoft Corporation Drinking Guidelines: Drinking Guidelines No more than 1 standard drink per day No more than 2-3 drinks on any drinking day (binge drinking) Limits for older women should be somewhat less than for older men (Source: NIAAA, 1995; Dufour andamp; Fuller, 1995) Drinking Guidelines (continued): Drinking Guidelines (continued) Recommendations consistent with data on benefits/risks of drinking in this age group Lower limits for older adults because: Increased alcohol sensitivity with age Greater use of contraindicated medications Less efficient liver metabolism Less body mass/fat increases circulating levels Defining Alcohol Use Patterns: Defining Alcohol Use Patterns Abstinence Low risk At-risk Problem Dependent No alcohol use for past year Alcohol use with no problems Alcohol use with increased chance of problems/ complications Experiencing adverse consequences Loss of control, drinking despite problems, physiological symptoms (tolerance, withdrawal) Alcohol Use Patterns (continued): Alcohol Use Patterns (continued) Older Adults and Alcohol Use: Older Adults and Alcohol Use Increased risk of: Stroke (with overuse) Impaired motor skills (e.g., driving) at low level use Injury (falls, accidents) Sleep disorders Suicide Interaction with dementia symptoms ©2002 Microsoft Corporation Older Adults and Use (continued): Older Adults and Use (continued) Other effects: Higher blood alcohol concentrations (BAC) from dose More impairment from BAC Medication effects: Potential interactions Increased side effects Compromised metabolizing (especially psychoactive medications, benzodiazepines, barbiturates, antidepressants, digoxin, warfarin) ©2002 Microsoft Corporation Social Work Screening: Social Work Screening Who? What? How? If aged 60 or over If physical signs are present If undergoing major life changes Screen for alcohol and prescription drug use/abuse During any regular service Utilize brown bag approach Ask direct questions Avoid stigmatizing terms General Issues for Older Adults: General Issues for Older Adults Loss (status, people, vocation, health, etc.) Social isolation, loneliness Major financial problems Housing changes Family concerns Time management burden Complex medical issues Multiple medications Sensory deficits Reduced mobility Cognitive impairments Impaired self-care, loss of independence Signs of Potential Alcohol Problems: Signs of Potential Alcohol Problems Anxiety, depression, excessive mood swings Blackouts, dizziness, idiopathic seizures Disorientation Falls, bruises, burns Headaches Incontinence Memory loss Unusual response to medications New difficulties in decision making Poor hygiene Poor nutrition Sleep problems Family problems Financial problems Legal difficulties Social isolation Increased alcohol tolerance Special Populations: Special Populations Barriers to effective identification exist for: Women Certain minority group members/lack of culturally competent tools and interventions Individuals with physical disabilities, comorbidities Homebound ©2002 Microsoft Corporation Co-morbid Conditions: Co-morbid Conditions Impaired Activities of Daily Living (ADL’s) Psychiatric symptoms, mental disorders Alzheimer’s disease Sleep disorders ©2002 Microsoft Corporation Co-morbidity is a serious, common concern among older adults using alcohol: Screening for Alcohol Use Problems in Older Adults: Screening for Alcohol Use Problems in Older Adults Goals Identify at-risk drinkers problem drinkers dependent drinkers Determine the need for further diagnostic assessment Rationale Incidence is high enough to justify costs Adverse quality/ quantity of life effects are significant Effective treatment exists Valid and cost-effective screening exists Screening Instruments: Screening Instruments Short Michigan Alcohol Screening Test-Geriatric Version (SMAST-G) Health Screening Survey (quantity/frequency and CAGE questions embedded in a general health survey) CAGE (Cut down, Annoyed by others, feel Guilty, need Eye opener) S-MAST-G: S-MAST-G Yes or no answers to: 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?' S-MAST-G (continued): S-MAST-G (continued) 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?' S-MAST-G (continued): S-MAST-G (continued) 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?' 2 or more positive responses = indicative of an alcohol abuse problem (range of scores of 0-10 possible) Quantity/Frequency Screen: Quantity/Frequency Screen 1. 'Do you drink alcohol?' 2. 'On average, how many days a week do you drink?' 3. 'On a day when you drink alcohol, how many drinks do you have?' 4. 'What is the maximum number of drinks you consumed on any given occasion in the past month?' 8 or more drinks/week or 2 or more occasions of binge drinking in last month are indicative of alcohol use problems. Screening Results: Screening Results Intervention with Older Adults: Intervention with Older Adults Preventive education for abstinent, low-risk drinkers Brief, preventive intervention with at-risk and problem drinkers Alcoholism treatment for abusing/dependent drinkers ©2002 Microsoft Corporation Brief Intervention: Brief Intervention Time-limited (5 mins, up to 5 brief sessions) Targeted at a specific behavior Goal directed Reducing alcohol consumption, and/or Facilitating entry into formal treatment Relies on negotiated goals Empirical support with younger drinkers across multiple settings Brief Intervention (continued): Brief Intervention (continued) Project GOAL (Guiding Older Adult Lifestyles) Univ. of Wisconsin Brief physician advice for at-risk older drinkers n=156 Reduced consumption at 12 months by 35-40% Health Profile Project Univ. of Michigan Elder-specific motivational enhancement session n=454 Preliminary findings: reduced at-risk drinking at 12 months Brief Protocols with Older Adults: Brief Protocols with Older Adults Brief intervention/motivational enhancement are effective approaches Accepted well by older adults Can be conducted at home or in clinic Reduces alcohol use Reduces alcohol-related harm Reduces health care utilization Brief Protocols (continued): Brief Protocols (continued) Ten components: Identify future goals (health, activities, etc.) Customize feedback Define drinking patterns Discuss pros/cons of drinking (motivation to change) Discuss consequences of heavier drinking Brief Protocols (continued): Brief Protocols (continued) Ten components: Identify reasons to cut down or quit drinking Setting sensible limits, devising strategies Develop a drinking agreement Anticipate and plan for risky situations Summary of the brief session Other Treatment Approaches: Other Treatment Approaches Cognitive-behavioral therapy Group-based counseling Individual counseling Medical/psychiatric approaches Marital and family involvement/family therapy Case management/ community-linked services andamp; outreach Formalized substance abuse treatment Conclusions: Conclusions Screening for alcohol use problems among older adults is effective Brief interventions are effective Additional interventions complete a spectrum of effective approaches Treatment approach depends on client background; assessment of needs, goals, resources; and preferences Intervention is available Conclusions (continued): Conclusions (continued) Older adults benefit from screening, assessment, referral, prevention, and intervention delivered by social workers who are sensitive to elder issues: Non-judgmental approach Motivational Supportive approach Recommendations : Recommendations Social workers in any setting with older adult clients should be prepared for: Recognition and assessment of alcohol use problems (quantity and frequency; limits) Structured brief interventions when appropriate Initial management and referral for further assessment/treatment when indicated You do not have the permission to view this presentation. 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Module 10 C Older Adults Haggrid Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 366 Category: Entertainment License: All Rights Reserved Like it (0) Dislike it (0) Added: August 07, 2007 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... By: zinthaq (37 month(s) ago) Interventions are either direct, typically involving a confrontative meeting with the alcohol or other drug dependent person (the most typical type of intervention) or indirect, involving work with a co-dependent family to encourage them to be more effective in helping the addicted individual [url="http://www.drug-intervention.com/missouri-drug-intervention.html"]Drug Intervention Missouri[/url] Saving..... Post Reply Close Saving..... Edit Comment Close By: misba (41 month(s) ago) hat ethical issues are likely to arise in the course of assessment/diagnosis related to alcohol use problems? --------------------- Misbah [url=http://www.drug-intervention.com/id aho-drug-intervention.html]Drug Intervention Idaho[/url] Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Older Adults and Alcohol Problems: Older Adults and Alcohol Problems NIAAA Social Work Education Module 10C (revised 3/04) Outline: Outline Prevalence Drinking guidelines Issues unique to older adults Co-morbid medical and psychiatric conditions Screening and detection Prevention, brief alcohol intervention and treatment Summary and recommendations Prevalence…: Prevalence… Depends on definition of at-risk or problem drinking: 1-15% of older adults are at-risk or problem drinkers Differs with sampling approach Alcohol use problems are the most common substance issues for older adults. Confounded by prescription, herbal, and over-the-counter medications Prevalence (continued): Prevalence (continued) Older adults with alcohol use problems are not recognized by many professionals Few older adults with alcohol abuse or dependence seek help in specialized addiction treatment settings ©2002 Microsoft Corporation Drinking Guidelines: Drinking Guidelines No more than 1 standard drink per day No more than 2-3 drinks on any drinking day (binge drinking) Limits for older women should be somewhat less than for older men (Source: NIAAA, 1995; Dufour andamp; Fuller, 1995) Drinking Guidelines (continued): Drinking Guidelines (continued) Recommendations consistent with data on benefits/risks of drinking in this age group Lower limits for older adults because: Increased alcohol sensitivity with age Greater use of contraindicated medications Less efficient liver metabolism Less body mass/fat increases circulating levels Defining Alcohol Use Patterns: Defining Alcohol Use Patterns Abstinence Low risk At-risk Problem Dependent No alcohol use for past year Alcohol use with no problems Alcohol use with increased chance of problems/ complications Experiencing adverse consequences Loss of control, drinking despite problems, physiological symptoms (tolerance, withdrawal) Alcohol Use Patterns (continued): Alcohol Use Patterns (continued) Older Adults and Alcohol Use: Older Adults and Alcohol Use Increased risk of: Stroke (with overuse) Impaired motor skills (e.g., driving) at low level use Injury (falls, accidents) Sleep disorders Suicide Interaction with dementia symptoms ©2002 Microsoft Corporation Older Adults and Use (continued): Older Adults and Use (continued) Other effects: Higher blood alcohol concentrations (BAC) from dose More impairment from BAC Medication effects: Potential interactions Increased side effects Compromised metabolizing (especially psychoactive medications, benzodiazepines, barbiturates, antidepressants, digoxin, warfarin) ©2002 Microsoft Corporation Social Work Screening: Social Work Screening Who? What? How? If aged 60 or over If physical signs are present If undergoing major life changes Screen for alcohol and prescription drug use/abuse During any regular service Utilize brown bag approach Ask direct questions Avoid stigmatizing terms General Issues for Older Adults: General Issues for Older Adults Loss (status, people, vocation, health, etc.) Social isolation, loneliness Major financial problems Housing changes Family concerns Time management burden Complex medical issues Multiple medications Sensory deficits Reduced mobility Cognitive impairments Impaired self-care, loss of independence Signs of Potential Alcohol Problems: Signs of Potential Alcohol Problems Anxiety, depression, excessive mood swings Blackouts, dizziness, idiopathic seizures Disorientation Falls, bruises, burns Headaches Incontinence Memory loss Unusual response to medications New difficulties in decision making Poor hygiene Poor nutrition Sleep problems Family problems Financial problems Legal difficulties Social isolation Increased alcohol tolerance Special Populations: Special Populations Barriers to effective identification exist for: Women Certain minority group members/lack of culturally competent tools and interventions Individuals with physical disabilities, comorbidities Homebound ©2002 Microsoft Corporation Co-morbid Conditions: Co-morbid Conditions Impaired Activities of Daily Living (ADL’s) Psychiatric symptoms, mental disorders Alzheimer’s disease Sleep disorders ©2002 Microsoft Corporation Co-morbidity is a serious, common concern among older adults using alcohol: Screening for Alcohol Use Problems in Older Adults: Screening for Alcohol Use Problems in Older Adults Goals Identify at-risk drinkers problem drinkers dependent drinkers Determine the need for further diagnostic assessment Rationale Incidence is high enough to justify costs Adverse quality/ quantity of life effects are significant Effective treatment exists Valid and cost-effective screening exists Screening Instruments: Screening Instruments Short Michigan Alcohol Screening Test-Geriatric Version (SMAST-G) Health Screening Survey (quantity/frequency and CAGE questions embedded in a general health survey) CAGE (Cut down, Annoyed by others, feel Guilty, need Eye opener) S-MAST-G: S-MAST-G Yes or no answers to: 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?' S-MAST-G (continued): S-MAST-G (continued) 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?' S-MAST-G (continued): S-MAST-G (continued) 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?' 2 or more positive responses = indicative of an alcohol abuse problem (range of scores of 0-10 possible) Quantity/Frequency Screen: Quantity/Frequency Screen 1. 'Do you drink alcohol?' 2. 'On average, how many days a week do you drink?' 3. 'On a day when you drink alcohol, how many drinks do you have?' 4. 'What is the maximum number of drinks you consumed on any given occasion in the past month?' 8 or more drinks/week or 2 or more occasions of binge drinking in last month are indicative of alcohol use problems. Screening Results: Screening Results Intervention with Older Adults: Intervention with Older Adults Preventive education for abstinent, low-risk drinkers Brief, preventive intervention with at-risk and problem drinkers Alcoholism treatment for abusing/dependent drinkers ©2002 Microsoft Corporation Brief Intervention: Brief Intervention Time-limited (5 mins, up to 5 brief sessions) Targeted at a specific behavior Goal directed Reducing alcohol consumption, and/or Facilitating entry into formal treatment Relies on negotiated goals Empirical support with younger drinkers across multiple settings Brief Intervention (continued): Brief Intervention (continued) Project GOAL (Guiding Older Adult Lifestyles) Univ. of Wisconsin Brief physician advice for at-risk older drinkers n=156 Reduced consumption at 12 months by 35-40% Health Profile Project Univ. of Michigan Elder-specific motivational enhancement session n=454 Preliminary findings: reduced at-risk drinking at 12 months Brief Protocols with Older Adults: Brief Protocols with Older Adults Brief intervention/motivational enhancement are effective approaches Accepted well by older adults Can be conducted at home or in clinic Reduces alcohol use Reduces alcohol-related harm Reduces health care utilization Brief Protocols (continued): Brief Protocols (continued) Ten components: Identify future goals (health, activities, etc.) Customize feedback Define drinking patterns Discuss pros/cons of drinking (motivation to change) Discuss consequences of heavier drinking Brief Protocols (continued): Brief Protocols (continued) Ten components: Identify reasons to cut down or quit drinking Setting sensible limits, devising strategies Develop a drinking agreement Anticipate and plan for risky situations Summary of the brief session Other Treatment Approaches: Other Treatment Approaches Cognitive-behavioral therapy Group-based counseling Individual counseling Medical/psychiatric approaches Marital and family involvement/family therapy Case management/ community-linked services andamp; outreach Formalized substance abuse treatment Conclusions: Conclusions Screening for alcohol use problems among older adults is effective Brief interventions are effective Additional interventions complete a spectrum of effective approaches Treatment approach depends on client background; assessment of needs, goals, resources; and preferences Intervention is available Conclusions (continued): Conclusions (continued) Older adults benefit from screening, assessment, referral, prevention, and intervention delivered by social workers who are sensitive to elder issues: Non-judgmental approach Motivational Supportive approach Recommendations : Recommendations Social workers in any setting with older adult clients should be prepared for: Recognition and assessment of alcohol use problems (quantity and frequency; limits) Structured brief interventions when appropriate Initial management and referral for further assessment/treatment when indicated