Addressing the needs of older substance misusers Dr Millicent Chikoore, Dr Nicholas Seivewright Sheffield Care Trust

Background Increasing numbers of older substance misusers Increasingly use illicit drugs, not just prescribed drugs and alcohol Range of social, psychological, health problems Crome & Bloor 2005, Gossop &Moos 2008.

Background (continued) Our service Accustomed to young population Little provision for basic level medical services Referral to specialist medical service infrequent Does it appeal to older individuals (different behavioural and clinical manifestations) or is different approach required?

Method Analysis of clinical notes of all aged >50years in Sheffield substance misuse service in May 2008 , misusing substances other than alcohol.

Results n=40

Ages

Age at onset of misuse

Source of substances n=40

Substances used

Circumstances during which misuse began

Significant physical illness

Impaired mobility(impacting on outpt attendance)

Formal psychiatric diagnoses

2 deaths during period of analysis Contributing factors Polydrug & alcohol misuse Initiation of heroin in later life (introduced by younger carer) MI Incontinence & pressure sores Self discharge from hospital Psychological factors-threatening behaviour leading to city-wide ban from primary care services, self harm by knifing in groin

Discussion Drug users are surviving into old age-captured by national data sets Unique factors in this age group-physical, psychological, social Younger people prioritised in addiction policies Large evidence base –epidemiological data, effective treatments, however older individuals often excluded No specific service provision in UK

Discussion continued Management of older adults requires different approach? Implications for services already stretched Specialist psychogeriatric services? Need for effective interventions in appropriate settings to reduce overall expenditure