Conference report: Grey Matters
On 1 April 2015 NCETA hosted a national conference on alcohol and drugs among older people. The aims of the Grey Matters Conference: Preventing and responding to alcohol and other drug problems among older Australians were to:
- Promote better understanding, and raise awareness of, alcohol and other drug (AOD) issues as they impact older Australians
- Clarify the implications, for the aged care sector and the alcohol and other drug prevention / treatment sector, of trends in AOD use among older Australians
- Identify possible ways forward for cross-sectoral initiatives and response strategies.
Internationally renowned speakers addressed a wide range of issues. Professor Ann Roche highlighted how Australia’s population is ageing at a faster rate than ever before and how ageing can predispose to increased AOD harm. Older people increasingly use illicit drugs and alcohol which will dramatically increase substance use problems and have major implications for prevention and treatment services. Professor Paul Haber indicated that alcohol and other drug services are experiencing an influx of older clients, many of whom have complex co-morbidities and other problems. AOD services were described as needing facilities which are accessible to older people; better integrated with other services; and with opioid substitution therapy more accessible. This was especially important as problem AOD use is akin to premature ageing according to Professor Brian Draper who noted that older people are particularly vulnerable to the effects of alcohol and other drugs which can cause and exacerbate cognitive impairment, depression and physical health problems. At a service delivery level, older people are seldom screened for alcohol and other drug problems and even when problems are identified, this doesn’t generally lead to intervention, according to Dr Stephen Bright. Effective screening tests are available, but not widely implemented.
The role of modern medicines in improving the lives of older people was examined by Associate Professor Craig Whitehead, Associate Professor Debra Rowett, Professor Mary Luszcz, but it was noted that they are also major contributors to morbidity and mortality, with one in three unplanned hospital admissions among 75+ year olds related to medicines use, and half of these are preventable. Poor medicine use can involve: too few or too many drugs, or incorrect dosages. Adverse drug effects can masquerade as a range of symptoms or be mistaken for the ageing process. Older Australians on average take 3.2 medications, 89% take at least one and 25% take at least five medications, one third use non-prescription and prescription combinations, with persistent use of psychotropic drugs a significant risk factor for fractures.
Professor Leon Lack highlighted that self-perceived sleeping difficulties were prevalent, although insomnia does not increase with age, and sleep symptoms among older people widely treated with medications (particularly benzodiazepines) despite lack of efficacy. In contrast, cognitive behavioural treatment was noted as an effective and durable treatment for insomnia.
The close links between AOD problems and posttraumatic stress disorder (PTSD) was examined by Professor Malcolm Battersby. Lifetime PTSD prevalence is approximately 8% among the general population and 1.5-4% among those over 60 and is associated with poorer self-rated health, multiple medical problems and a doubling of the risk of developing dementia. Cognitive behaviour therapy is an effective treatment for PTSD.
Use of opioids by older Australians for chronic non-cancer pain has increased substantially over the past 15 years despite lack of evidence of efficacy and increased levels of harm according to Dr Tim Semple. However, pain remains undertreated among older Australians. People with common mental health disorders are three times more likely to be prescribed opioids for pain. The need to enhance quality of pain management, especially use of non-pharmacological approaches, was highlighted.
From a consumer advocacy perspective Mr Ian Yates described how older Australians are often regarded as an economic and social liability despite substantial contributions to society. Older people’s right to make lifestyle choices concerning alcohol and other drug use was stressed, together with not being subjected to potentially harmful prescribing practices (such as chemical restraint) and the importance of being able to access appropriate services.
In closing, the commonalities between the AOD and aged care sectors were illustrated by Professor Margaret Hamilton, specifically the need for appropriate human and service responses. She stressed the critically importance of stimulating older people and keeping active; but acknowledged that this can be difficult if there is a history of complex problems and isolation from families. She noted that our response systems need to be redesigned to facilitate this care and to break down service provision silos and develop the workforce to respond to these cross sectoral issues.