Substance Misuse and Older Vulnerable Adults

1
Substance Misuse and Older Vulnerable Adults
CNMC
Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
Professionals in Wales
Denise Shanahan Cardiff and Vale NHS Trust
2
Substance Misuse and Older Vulnerable Adults
A hidden problem
The extent of which is unclear, underestimated,
underidentified, underdiagnosed, and
undertreated.
The Generals Family http//www.amazingartimages.co
m
Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
Professionals in Wales
CNMC
3
Recognition and reporting is compounded by
definitions of old age
Chronological or biological age Historically in
health care older adults (geriatrics) referred to
people aged 65 years and older The Commissioner
for Older People in Wales works with and for
people over the age of 60 The NSF for Older
People in Wales refer to people over the age of 50
Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
Professionals in Wales
CNMC
4
Age of retirement? Demographic changes- people
are generally living longer The older of the
old that is the 85 years and above is the
greatest growing proportion of the
population Adults may misuse substances at any
age and may begin or continue to or do so in
older age
Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
Professionals in Wales
CNMC
5
Life changes may add to problems of recognition
After retirement, there is no employer to note
poor work performance Some older adults
become socially isolated Adult children may live
elsewhere There may be no cohabitant to
recognise the problem Pride- they may hide their
substance misuse Family and friends may
inadvertently enable the clients substance
misuse by denying the problem
Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
Professionals in Wales
CNMC
6
Abuse of heroin and other opioids by older adults
is currently relatively rare Substances abused
or misused by older adults mainly include
alcohol, tobacco, prescription and
over-the-counter medications Older people are
vulnerable to substance misuse because they
generally take more prescription drugs than other
age groups Drug interactions are likely to be
worse in older adults because of slowed
metabolism and clearance mechanisms
Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
Professionals in Wales
CNMC
7
Recognition is complicated

• Substance misuse in older adults can be mistaken
  for
• Dementia
• Side effects or adverse
• reactions to medication
• The worsening of an
• existing chronic illness
• Depression
• Anxiety
• Age related changes

Stigma Ageist beliefs Lack of knowledge
Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
Professionals in Wales
CNMC
8
Recognition is complicated
Substance misuse and medical problems in older
people can have similar symptoms

• General symptoms
• Hypertension
• Congestive heart
• disease
• Heart arrhythmias
• Gastritis
• Anorexia
• Malnutrition

Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
Professionals in Wales
CNMC
9

• Mood changes

• Depression
• Altered response to stress

Cognitive changes

• Disorientation
• Recent memory loss
• Slowed thought process

Motor, gait or dexterity changes

• Muscle in coordination
• Tremors
• Falls
• Inflammation of joints

Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
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CNMC
10
Misuse and Errors

• Sensory impairments can also increase the risks
  of error-
• A person with a hearing problem may not hear
  instructions for taking medications correctly
• Poor vision may make it difficult to correctly
  read labels
• Physical ailments such as arthritis, weakness,
  and loss of coordination can also pose problems,
  such as difficulty opening bottles and strips of
  tablets

Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
Professionals in Wales
CNMC
11
Cannabis Gran
2007
Cannabis grandmother spared jail
A 68-year-old grandmother convicted of growing
cannabis at her Northumberland home has been
given a 250 hour community service order.
Patricia Tabram defended herself during the court
case
http//news.bbc.co.uk/1/hi/england/tyne/6426831.st
m
Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
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CNMC
12
                      Home
Inside Out Extra Monday March 21, 2005
Her first experience of trying to buy cannabis
was bemusing and would probably terrify most old
age pensioners, as she explains. "The first
cannabis I bought, I was told to go to a pub in
Newcastle. I stood there looking out of place
with my shopping trolley Eventually Pat found a
dealer who sold her a small bag of cannabis for
20.

http//www.bbc.co.uk/insideout/extra/series2/canna
bis.shtml
Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
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CNMC
13
2003

A pensioner has walked free from court after
supplying cannabis to her 85-year-old partner to
help his arthritis.
A 62 year old female of Abertridwr, near
Caerphilly, south Wales, was released after the
judge heard she was giving the drug to her
ex-miner partner in his battle against pain.
She was given a 12 month community
rehabilitation order and ordered to pay 50 costs
http//news.bbc.co.uk/1/hi/wales/3197906.stm
Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
Professionals in Wales
CNMC
14
2006

The 70 year old admitted producing the drug at
his home between September 2005 and February
2006.
http//news.bbc.co.uk/1/hi/scotland/south_of_scotl
and/6154936.stm
Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
Professionals in Wales
CNMC
15
2008
OAP, 70, 'sold heroin in garden'

The 70 year old sold heroin that was kept in a
tin hidden in a compost heap. A jury at Swansea
Crown Court found Davies guilty of possessing
heroin with intent to supply.
A pensioner is facing jail after he was
convicted of dealing heroin from his back garden
in Swansea to supplement his pension.
http//news.bbc.co.uk/1/hi/wales/7329122.stm
Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
Professionals in Wales
CNMC
16
Substance Misuse and Abuse
2005
Officers said the plants at the house in Skewen
were high-quality cannabis worth more than
5,000.
http//news.bbc.co.uk/1/hi/wales/4528040.stm
Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
Professionals in Wales
CNMC
17
Substance Misuse and Abuse

• Older people as carers
• Partners
• Neighbours
• Friends
• Grandchildren
• Voluntary work

• Older people as receivers of care
• From partners
• From neighbours
• From friends
• From family members
• From paid carers
• From voluntary workers

Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
Professionals in Wales
CNMC
18
Substance Misuse and Abuse
Vulnerable Adult current working definition
A person who is 18 years of age or over, and
who is or may be in need of community care
services by reason of mental or other disability,
age or illness and who is or may be unable to
take care of him/herself, or unable to protect
him/herself against significant harm or serious
exploitation.
Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
Professionals in Wales
CNMC
19
Abuse
Research suggests that hundreds of thousands of
elderly people are being abused in their own
homes The study, funded by the Department of
Health and Comic Relief, suggests that in 8 out
of 10 cases the abuser is someone well known to
the elderly person
UK Study of Abuse and Neglect of Older People
Prevalence Survey Report http//www.comicrelief.co
m/docs/elder-abuse/ComicRelief-ElderAbuse-Full.pdf

Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
Professionals in Wales
CNMC
20
Substance Misuse and Abuse

• The report found
• Of perpetrators of financial abuse
• 30 were reported to have problems with
• alcohol use
• 8 were reported to have problems with drug
• use
• Of perpetrators of psychological, physical and
  sexual abuse
• 5 were reported to have problems with
• alcohol use

Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
Professionals in Wales
CNMC
21
Substance Misuse
Has implications for older adults As well as
individuals, communities and society Can
compromise physical, mental, psychological and
social health and well being Can lead to risky
behaviours, compromising safety and dignity May
contribute to Abuse Can impair decision
making
Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
Professionals in Wales
CNMC
22
Mental Capacity Act

• The five statutory principles are
• A person must be assumed to have
• capacity unless it is established that they
• lack capacity.
• A person is not to be treated as unable to make a
  
• decision unless all practicable steps to help
  him
• to do so have been taken without success
• A person is not to be treated as unable to make a
• decision merely because he makes an unwise
• decision

Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
Professionals in Wales
CNMC
23
Mental Capacity Act

• An act done, or decision made, under this Act for
  or on behalf of a person who lacks capacity must
  be done, or made, in his best interests.
• Before the act is done, or the decision is made,
  regard must be had to whether the purpose for
  which it is needed can be as effectively achieved
  in a way that is less restrictive of the persons
  rights and freedom of action.

Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
Professionals in Wales
CNMC
24
Test of mental capacity is undertaken in two
stages Stage 1 Does the person have an
impairment of, or a disturbance in the
functioning of, their mind or brain? An example
of impairment or disturbance in the functioning
of the mind or brain may include the symptoms of
drug or alcohol use. Older people may take longer
to recover from these effects
If there is a chance that the person will regain
the capacity to make a particular decision, then
it may be possible to put off the decision until
later if it is not urgent
Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
Professionals in Wales
CNMC
25
Substance Misuse and Older Vulnerable Adults

• Specialist services are needed that address the
  particular needs of older people
• Tailored educational programmes
• Age appropriate groups/ services
• Access to services that cater for physical and
  mental frailty

Knowledge, skills and attitudes need to be
influenced across the whole population including
public and professionals
Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
Professionals in Wales
CNMC
26
When you engage with older adults. Who do you
see?
http//www.amazingartimages.com
Consultant Nurse and Midwife Cymru The Forum for
Consultant Nurses, Midwives and Allied Health
Professionals in Wales
CNMC