First Responders: Drug Abuse and Drug Misuse Among Older Adults

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First Responders Drug Abuse and Drug Misuse
Among Older Adults

• Rhode Island Elder Mental Health and Addiction
  Coalition and
• Rhode Island Elderly and Addiction Recovery
  Taskforce
• October 26, 2011

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Officer Sandra Marinucci West Warwick Police
DepartmentElderly Affairs AdvocateJanet
Spinelli, RN, PCNSRI Division of Behavioral
HealthCare
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Why is the Problem Getting Worse?

• 20 of the population is expected to be 65 or
  older by 2030.
• 66 of men and 65 of women use alcohol (Blazer
  Wu, 2009).
• Seventy six of adults 60 and over use two or
  more prescription drugs and 37 use five or more
  (Gu, et al., 2010).
• One in four older adults may use prescription
  medication with abusive potential (Blow, 2011).1

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Why is the problem getting worse? (cont.)

• By 2020, non-medical use of prescription drugs
  among adults 50 and over will increase
  dramatically (Simoni-Wastila Yang, 2006).
• One in five older adults may be affected with
  difficulties from alcohol and medication misuse
  (Blow, 2011).1
• Non-medical use of prescription drugs was as
  common as marijuana use among adults aged 60 or
  over (NSDUH, 2007-2009).2
• Aging Baby Boomers are predicted to triple
  marijuana use among persons aged 50 or over
  between 1999/2001 and 20201(NSDUH, 2007-2009).2
• Source 1Blow, F., 2011. Substance Use Disorders
  Among Older Adults. Available at
  http//www.nattc.org
• 2Substance Abuse and Mental Health Services
  Administration, Center for Behavioral Health
  Statistics and Quality. (September 1, 2011). The
  National Survey on Drug Use and Health Report.
  Illicit Drug Use among Older Adults. Rockville,
  MD.

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Why is the Problem So Serious?

• 2006-Overall deaths caused by overdose of
  pharmaceuticals has exceeded deaths from traffic
  accidents. (T. Prough, DEA from CDC June 18,
  2010).
• Overdose deaths in RI-9th in US Average 2-3 per
  week (T. Green, 2011).
• Older adults present unique challenges requiring
  different strategies for problem recognition
  (NSDUH 2007-2009).
• Education is needed to can change perception of
  the problem.

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Early Intervention Treatment

• Early intervention works!
• Early intervention can prevent unintentional drug
  poisoning.
• Early intervention may improve medical care for
  the many health conditions associated with drug
  abuse (NSDUH 2007-2009).
• Treatment can reduce ER visits, hospitalization,
  institutionalization, overdose, and death
  associated with illicit drug and pharmaceutical
  use.

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Police and Fire First Responder
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How were you dispatched?

• Who is the caller?
• 911
• Lifeline
• Concerned family member, friend or neighbor
• What is the nature of the call?
• Medical
• Well being check
• Self initiated
• Wandering

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Common Situations

• Wandering
• Unusual or Risky behaviors
• Not making sense
• Mood changes
• Environmental risk
• Falls/Injuries
• Requesting help with personal care
• Intoxication
• Complaints with neighbors

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Potential Impairments

• Hearing deficit
• Visual deficit
• Speech deficits
• Language issues
• Specialized communication needs
• Cognitive impairment
• Intellectual special needs
• Medical issues/Medication reaction issues
• Drug and Alcohol intoxication issues

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Initial Contact

• Try to establish rapport and trust.
• Respect personal space.
• Follow their lead, try not to rush the situation.
• Use slow, even, and low speech.
• Avoid talking down to the individual.
• Use a sit and chat scenarios when possible.
• Do not argue, use listening.

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Recognizing Substance Abuse

• Communication
• What difficulties are you having?
• What concerns do you have?
• How can we help you?
• Can they hold a conversation?
• Use short sentences.
• Use non-verbal communication.
• Can they talk about current events?
• Look for common signs of drug abuse.

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Responding Elders Home

• Look around the home.
• Are there fire hazards?
• Are windows or doorways blocked?
• Are there building violations?
• Are wires exposed?
• Smoke detectors?
• Deplorable conditions?
• Dog, cat, human feces on the floor
• Bugs
• Is there food?
• When was the last time they ate?
• Check the refrigerator
• Is this person able to care for themselves?
• If the answer is No, they need to go to the
  hospital
• Document everything.
• Police and Fire Take photos.

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Fire Police First Responderand Hospital
Collaboration

• If time prevails, respond to the hospital.
• Talking to triage
• Locate the charge nurse, social services and/or
  the doctor. Give them the history and data on
  living conditions.
• Report anything of importance.
• Be descriptive and give details.
• Recognize and report repetitive incidences.
• Address discharge planning, if appropriate.
• Consider recidivism and related history.

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Coordination with Social Services

• Mandatory Reporting DEA fax a copy to them
  ASAP 401-462-0545
• The Point 211/www.DEA.RI.GOV
• ER card
• Case management agencies
• West Bay Community Action West Warwick,
  Coventry, Warwick, East Greenwich, West Greenwich
  (401-732-4660)
• Child Family Services of Newport
  (401-845-2270)
• East Bay Community Action (401-437-1000)
• Tri-Town Community Action
• Southern RI (401-789-3016 x7)
• Providence Northern RI (401-349-5760 x3)
  

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First ResponseIntegration with Treatment
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How can we Partner to Address Substance Misuse?

• Screen Scan the Environment
• Recognize Signs of Health and Safety Risk
• Develop Opportunities to use Motivation,
  Education, and Other Brief Interventions
• Balance Privacy vs. Health Concerns
• Refer to Treatment

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Recognizing Common Scenarios

• Elders with Substance Use Issues
• Self Neglect
• Environmental Community Safety Issues
• Abusive Caregiver
• Elder Victims of Abuse or Neglect from
• Substance Abusing Caregivers

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Possible Signs of Drug Use

• Physical or Emotional Indicators
• Smell of alcohol or marijuana on clothes
• Burned fingers, lips, or needle track marks
• Slurs speech, stutters, or incoherent
• Dilated or constricted pupils
• Tremors of hands or eyelids
• Hyperactive or overly energetic
• Lethargic or falls asleep easily
• Impaired coordination, staggering, off balance
• Speaks rapidly or slowly
• Mood swings, fearful or anxious
• Impatient, agitated, irritable, angry or defiant
• Behavioral Indicators
• Impulsive or inappropriate
• Denies, lies or covers up breaks or bends rules

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Recognizing Possible Signs (Cont.)

• Cognitive Indicators
• Difficulty concentrating, focusing, attending to
  task
• Appears distracted or disoriented
• Makes inappropriate or unreasonable choices
• Difficulty making decisions
• Memory loss, or black outs
• Makes frequent errors, or needs repeated
  directions
• Difficulty recalling known details
• Needs repeated assistance completing ordinary
  paperwork
• Adapted from SAMHSA Tips for First Responders
  Possible Alcohol and Substance Abuse Indicators.
  Publication NMH05-0212 . Available at
  www.samhsa.gov

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Signs of Neglect in the Home

• Absence of necessities including food, water,
  heat
• Inadequate living environment evidenced by lack
  of utilities, sufficient space, and ventilation
• Animal or insect infestations
• Signs of medication mismanagement, including
  empty or unmarked bottles or outdated
  prescriptions
• Housing is unsafe as a result of disrepair,
  faulty wiring, inadequate sanitation, substandard
  cleanliness, or architectural barriers
• Source National Committee for the Prevention of
  Elder Abuse (NCPEA) March 2003.

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Signs of Neglect in the Home (Cont.)

• Physical indicators
• Poor personal hygiene including soiled clothing,
  dirty nails and skin, matted or lice infested
  hair, odors, and the presence of feces or urine
• Unclothed, or improperly clothed for weather
• Decubiti (bedsores) or skin rashes
• Dehydration, evidenced by low urinary output, dry
  fragile skin, dry sore mouth, apathy, lack of
  energy, and mental confusion
• Worsening dementia

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Signs of Neglect in the Home (Cont.)

• Physical Indicators (cont.)
• Untreated medical or mental conditions including
  infections, soiled bandages, and unattended
  fractures
• Absence of needed dentures, eyeglasses, hearing
  aids, walkers, wheelchairs, braces, or commodes
• Exacerbation of chronic diseases despite a care
  plan
• Source National Committee for the Prevention of
  Elder Abuse (NCPEA) March 2003.

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Signs of Caregiver Abuse in the Home

• Indicators for caregiver abuser
• Expresses anger, frustration, or exhaustion
• Isolates the elder from the outside world,
  friends, or relatives
• Obviously lacks care giving skills
• Is unreasonably critical and/or dissatisfied with
  social and health care providers and changes
  providers frequently
• Refuses to apply for economic aid or services for
  the elder and resists outside help
• Source National Committee for the Prevention of
  Elder Abuse (NCPEA) March 2003.

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Signs of Abuse

• Indicators observed in Abuse Victim
• Exhibits emotional distress such as crying,
  depression, or despair
• Has nightmares or difficulty sleeping
• Has had a sudden loss of appetite that is
  unrelated to a medical condition
• Is confused and disoriented (this may be the
  result of malnutrition)
• Is emotionally numb, withdrawn, or detached
• Exhibits regressive behavior
• Exhibits self-destructive behavior
• Exhibits fear toward the caregiver
• Expresses unrealistic expectations about their
  care
• Source National Committee for the Prevention of
  Elder Abuse (NCPEA) March 2003.

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Specialized Interventions with Older Adults
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Use Specialized Techniques

• LINK Concerns with Interview Questions.
• Ask DIRECT questions about identified concerns.
• PREFACE questions with link to medical, health or
  safety concerns.
• Use non-judgmental approach avoid stigmatizing
  terms.
• Adapted from F. Blow. (2011) Substance Use
  Disorders Among Older Adults. Available at
  http//www.nattc.org

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Screening leads to Treatment

• Ask about what drugs are used?
• alcohol, misuse/use of prescription drugs,
  marijuana, cocaine, inhalants, hallucinogens, or
  heroin
• How much? When?
• Identify recent intake, binge use, quantity and
  frequency
• What are the health conditions, functional issues
  and risks?
• Identify comorbid risks.

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Brief InterventionMotivation using the 4 Rs

• Relevance to the Older Adult
• Risks of Continued Use
• Rewards of Quitting
• Repetition at Each Encounter
• Source Blow, F. (2011) Substance Use Disorders
  Among Older Adults. Available at
  http//www.nattc.org

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Health Education Works

• A non judgmental and empathic educational
  approach can highlight personal responsibility
  and capacity for behavior change.
• Alcohol Issues
• Alcohol interacts with prescription drugs and
  affects balance, appetite, sleep, nutrition,
  blood glucose levels, memory, and cognition.
• Health risks Identify needs vs. adequate
  supports for medical, behavioral health and/or
  environmental issues.
• Education on Social Drinking Choosing drinks
  with lower alcohol content and mixing with non
  alcoholic beverages may reduce the risk of
  dangerous consumption.

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Health Education Works

• Prevention of Medication Misuse
• Use Only One Pharmacy.
• Ask your Health Care Provider or Pharmacist about
  potential side effects or drug interactions.
• Have a health care advocate.
• Report changes in health status to Health Care
  Providers.

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Other Specialized Strategies

• Establish Strength Based Approach for Consumer
  Directed Goal Setting.
• Engage in Brief Interventions for Problem
  Solving, Coping with Losses and Changes in Health
  Status.
• Support Self Care Management and Skill
  Development.
• Establish Social Connection Rebuild Social
  Supports.
• Promote Meaningful Day Activities.

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Resources

• Rhode Island Council on Alcoholism and Other Drug
  Dependence http//www.ricaodd.org/
• RI Department of Behavioral Healthcare,
  Developmental Disabilities and Hospitals
  http//www.bhddh.ri.gov/
• Substance Abuse and Mental Health Service
  Administration (SAMHSA) http//www.samhsa.gov/
• Addiction Technology Transfer Center (ATTC)
  Network http//www.nattc.org
• Alcohol Screening The Short Michigan Alcoholism
  Screening Test- Geriatric Version (SMAST-G)
  AUDIT-C, CAGE, MAST-Geriatric Version.
• The Drug Abuse Screening Test DAST