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

2. 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.

3. 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?

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

5. Results
n=40

6. Ages

7. Age at onset of misuse

8. Source of substances
n=40

9. Substances used

10. Circumstances during which misuse began

11. Significant physical illness

12. Impaired mobility(impacting on outpt attendance)

13. Formal psychiatric diagnoses

14. 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

15. 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

16. 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