Substance misuse in later life: challenges for primary care: a review of policy and evidence

Rao, Rahul; Crome, Ilana; Crome, Peter; Iliffe, Steve

doi:10.1017/s1463423618000440

Cited by 13 publications

(9 citation statements)

References 33 publications

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“…[ 26 ] Adequate funding for workforce development, healthcare infrastructure, and quality improvement is required to improve the health outcomes and life quality of high-risk individuals and problematic users. [ 27 ]…”

Section: Discussionmentioning

confidence: 99%

Marijuana use experiences and expectancies of urban youth in India

Ali

Sachdeva

Gupta³

et al. 2022

Journal of Family Medicine and Primary Care

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Objective: To gain information on the marijuana experiences and expectancies of youth in an urban Indian area, which may be used for forming the framework for the development of effective primary prevention strategies in the future. Method: This was a cross-sectional study conducted in various colleges of Mumbai; 260 students from three colleges who were above 18 years were selected by systematic random sampling. The participant had to fill a sociodemographic questionnaire and marijuana effect expectancy questionnaire (MEEQ-B) and it was analyzed by using the SPSS software. Results: A significant association was found between negative marijuana expectancies and type of family, with cannabis users and non-users, who want to try cannabis and those who are aware of the legal issues and harmful effects of cannabis. Conclusion: Preventive drug education should begin in early adolescence and should deter or delay drug use through changes in knowledge, attitude, behavior, and expectation. Adolescent drug education must meet the needs of those naive to drugs as well as those experiencing initial drug exposure. This is the first study which highlights the youth experiences and expectancies about marijuana in India.

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Section: Discussionmentioning

confidence: 99%

Marijuana use experiences and expectancies of urban youth in India

Ali

Sachdeva

Gupta³

et al. 2022

Journal of Family Medicine and Primary Care

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“…Older people prefer treatment plans which are accessible, non‐confrontational and supportive [51]. They may benefit from age‐ and gender‐tailored interventions which target different life domains [43,48,52–56]. Future studies should investigate what type of treatments older addiction service users are assigned to, the effectiveness of the provided treatments, if those treatments are age‐ and gender‐specific and address the complex needs of older people with problematic substance use.…”

Section: Discussionmentioning

confidence: 99%

Recurrent risk of hospitalization among older people with problematic alcohol use: a multiple failure‐time analysis with a discontinuous risk model

et al. 2022

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Background and aims Older people with problematic alcohol use vary in psychosocial functioning, age of onset for problem drinking and use of other drugs. The study measured the differential risks of all‐cause, alcohol‐, polydrug‐ and psychiatric‐related repeated hospitalizations among older people with problematic alcohol use. Design A linked register‐based cohort study with discontinuous multiple‐failure (time‐to‐repeated‐event) data. Hospitalization and mortality were considered as failure. Setting Sweden, March 2003–November 2017, using data from the Addiction Severity Index (ASI) register linked to National Inpatient Register and the Swedish cause of death register. Participants Participants aged 50 years and older (n = 1741; 28.2% women), with one or more alcohol problem days in the 30 days before an ASI assessment. Measurements Five mutually exclusive latent classes of problematic alcohol use, identified with 11 ASI items, were the independent variables: ‘late onset with fewer consequences (LO:FC; reference group)’; ‘early onset/prevalent multi‐dimensional problems (EO:MD)’; ‘late onset with co‐occurring anxiety and depression (LO:AD)’; ‘early onset with co‐occurring psychiatric problems (EO:PP)’; and ‘early onset with major alcohol problem (EO:AP)’. Covariates included socio‐demographic characteristics, previous hospitalization and Elixhauser comorbidity index. Outcome measurements included recurrent hospitalization and/or mortality due to: (a) all‐cause, (b) alcohol‐related disorders and diseases (c) polydrug use and (d) other psychiatric disorders. Findings During the study period, more than 75% were hospitalized at least once or died. 57.3% were hospitalized with alcohol‐related, 8.5% with polydrug use and 18.5% with psychiatric‐related diagnoses. Compared with LO:FC, EO:PP had higher risk for all‐cause [adjusted hazard ratio (aHR) = 1.27, 95% confidence interval (CI) = 1.02–1.59] and alcohol‐related (aHR = 1.34, 95% CI = 1.02–1.75) hospitalizations. Adjusted risks for polydrug‐related hospitalization were 2.55, 95% CI = 1.04–6.27 for EO:MD and 2.62, 95% CI = 1.07–6.40 for EO:PP. Adjusted risk for psychiatric‐related hospitalization was higher for LO:AD (aHR = 1.78, 95% CI = 1.16–2.73 and EO:PP (aHR = 2.03, 95% CI = 1.22–3.38). Conclusions Older addiction service users in Sweden have varying risks of hospitalization due to alcohol use, polydrug use and psychiatric disorders. Older people with problematic alcohol use who have multiple needs and are assessed in social services may benefit from earlier interventions with an integrated focus on substance use and mental health.

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“…For example, problematic use of alcohol and other drugs (AoD) including polypharmacy (over-the-counter and prescribed medication) is associated with increased use of emergency services and hospital admission [7,[13][14][15]. Older people with co-occurring conditions have been shown to experience delayed transfers after hospital admissions, premature transfer to long-term care and present more frequently with adult abuse [16][17][18]. For those with refractory alcohol problems, there is likely to be a growing demand for long-term specialist care [19].…”

Section: Problematic Substance Use In Later Lifementioning

confidence: 99%

Community Based Interventions for Problematic Substance Use in Later Life: A Systematic Review of Evaluated Studies and Their Outcomes

Hafford‐Letchfield

McQuarrie

Clancy

et al. 2020

IJERPH

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Problematic substance use (PSU) in later life is a growing global problem of significant concern in tandem with a rapidly ageing global population. Prevention and interventions specifically designed for older people are not common, and those designed for mixed-age groups may fail to address the unique and sometimes complex needs of ageing communities. We report findings from a systematic review of the empirical evidence from studies which formally evaluated interventions used with older people and reported their outcomes. Nineteen studies were included, of which thirteen focused solely on alcohol-related problems. Eight interventions utilised different types of screening, brief advice and education. The remaining drew on behavioural, narrative and integrated or multi-disciplinary approaches, which aimed to meet older people’s needs holistically. Quality assessment of study design helped to review evaluation practice. Findings point to recommendations for sustainable and well-designed intervention strategies for PSU in later life, which purposefully align with other areas of health and well-being and are delivered in locations where older people normally seek, or receive, help. There is further scope for engagement with older people’s own perspectives on their needs and help-seeking behaviours. Economic evaluation of the outcome of interventions would also be useful to establish the value of investing in targeted services to this underserved population.

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Substance misuse in later life: challenges for primary care: a review of policy and evidence

Cited by 13 publications

References 33 publications

Marijuana use experiences and expectancies of urban youth in India

Marijuana use experiences and expectancies of urban youth in India

Recurrent risk of hospitalization among older people with problematic alcohol use: a multiple failure‐time analysis with a discontinuous risk model

Community Based Interventions for Problematic Substance Use in Later Life: A Systematic Review of Evaluated Studies and Their Outcomes

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