1. Treating Co-Occurring Disorders in Geriatric Populations
Jeremy King, LMSW, CASAC

2. Objectives
Define co-occurring disorders and discuss how medical conditions should be included in this definition when discussing geriatric substance users
Identifying risk factors for geriatric substance use disorders, mental health disorders and medical conditions
Compare/Contrast rates of substance use, mental illness and medical comorbidities between geriatric and other populations
Identify best practices for the treatment of geriatric consumers with co- occurring disorders

3. Large Group Brainstorm
Name some of the risk factors for geriatric substance use and mental illness.

4. Definition of Co-Occurring Disorders
Co-Occurring Disorders: The co-existence of both a mental health and a substance use disorder-SAMHSA, 2014
If a medical condition and a mental health disorder occur at the same time, are these considered co-occurring disorders?
What about a medical condition and a substance use disorder?
What is co-morbidity?

5. Common Substances Used

6. Frequency of Co-Occurring Disorders (Mental Health Disorders)

7. Most Common Co-Occurring Mental Health Disorders
Current Program Population:
Major Depression
Mild Neurocognitive Disorder
Anxiety Disorders
Post Acute Withdrawal Associated Insomnia (not a diagnosis)
Bi-Polar Type II

8. Frequency of Co-Occurring Disorders (Medical Conditions)

9. Most Common Co-Occurring Medical Conditions
Current Program Population:
Hypertension
Diabetes
Hyperlipidemia (Elevated Cholesterol)
Benign Prosthetic Hyperplasia (Enlarged Prostate)
Osteoarthritis
COPD/Asthma
Cardiovascular Disease
Renal Disease

10. A Treatment Model for Geriatric Substance Abusers: Assessment
Comprehensive evaluation includes battery of mental health inventories and a comprehensive physical exam:
Beck Depression Scale
Patient Health Questionnaire (PHQ-9)
General Anxiety Disorder 7 Question Scale (GAD-7)
Self Evaluation Questionnaire (Anxiety)
Modified Mini Screen (Psychotic, anxiety, depression, bipolar, PTSD-symptoms)
History and Physical with bloodwork
(Collect collateral information from previous medical and psychiatric providers if possible; may become easier with EMR interoperability, RHIO’s, DSRIP Reforms, etc.)

11. A Treatment Model for Geriatric Substance Abusers With Co-Occurring Disorders: Diagnosis
Important to note that not all DSM-V criteria for substance use disorders are perfect fits for geriatric substance users:
Failure to fulfill role obligations (may already be reduced as nature part of life cycle changes)
Recurrent use in situation that are physically hazardous (may no longer drive or travel independently)
Social, occupational, recreational activities given up or reduced (See above)
Other Factors can impact accurate diagnosis:
Geriatric client’s inability to remember details of substance use
Unwillingness to disclose information related to mental health disorder because of fear of stigma

12. Cohort Older Adult Substance Users
A Treatment Model for Geriatric Substance Abusers With Co-Occurring Disorders: Treatment
Cohort Older Adult Substance Users
Take into consideration health problems and physical limitations
Respect is extremely important
Confrontational approaches are contra-indicated with geriatric populations and individuals with co-occurring disorders
Provide safe, quiet, well-lit, and easily accessible environment for geriatric clients with co-occurring disorders
Consider shorter treatment services including groups and individual counseling sessions

13. A Treatment Model for Geriatric Substance Abusers With Co-Occurring Disorders: Treatment
Provide services that address various psychiatric and medical conditions
Seeking Safety-PTSD
Cognitive Behavioral Therapy-Depression, Anxiety, Insomnia, Substance Use
Wellness Self Management Plus-Substance Use and Mental Health Disorders
Psychiatric Social Work-Complex Case Management

14. Medication Management
Medication management is an important issue for all geriatric individuals.
Provide opportunities to teach and educate:
While providing medication
Brief treatment from RN
Psycho-educational seminars
Doctor’s Visits
Counseling Sessions with clinician
Medication Independence Protocol (Being developed, implemented later this year).
All non-compliance should be discussed in case conference and documented in clinical chart.

15. Recreational Services
Consider low intensity activities (walking, modified yoga)

16. Discharge Planning Consider client placement in:
Long Term/Short Term Nursing Facility
(At least one member of your nursing staff should be trained in administering the PRI)
Skilled Nursing Facility/Assisted Living Facility
Congregate Care/Transitional/Scattered Site Mental Health Housing Programs
(Have one staff member
A31 OP Mental Health Treatment Program
Consider family members as appropriate

17. Discharge Planning and Recovery Support
Does client belong to health home?
Does client qualify for HCBS services?
Does client have a PCP in the community?
Does the client have a psychiatric provider in the community?
Does 822 referral provide geriatric specific services?
Does recovery support provider provide geriatric specific services?