Substance Abuse ‘Under-appreciated’ Among Elderly Psychiatric Inpatients

More than one in 10 admissions to an acute psychiatric inpatient geriatric psychiatry service was associated with an alcohol or drug use disorder in a retrospective examination of admissions for 1,788 patients over age 65 who were seen from 2001 to 2011.

“With more than 1 in 10 elderly patients meeting criteria for a substance use diagnosis in this population, clinicians should increase surveillance at all patient encounters in an effort to reduce the associated morbidity and mortality and improve functional status and quality of life for these individuals,” Dr. Dennis Dombrowski said in an interview.

Dr. Dennis Dombrowski: “Substance abuse is likely grossly underappreciated in this population secondary to reluctance of self report, inaccuracy of self report, health care provider attitudes, and also the different social circumstances of elderly patients.”

The total group had a mean age of 75.45 years and an average length of stay of 13.91 days. Of all 1,788 admissions, 11.7% (210) were associated with at least one substance abuse diagnosis. The most common was alcohol abuse, identified in 73% of the 210. Other substance abuse diagnoses included sedative hypnotic abuse/dependence in 11%, opiate abuse/dependence in 3%, cannabis use in 1%, tobacco use disorder in 1%, and unspecified drug-induced disorders/withdrawal in 39%. (The total is greater than 100% because some patients had more than one diagnosis.)

Compared with the psychiatric patients without substance abuse diagnoses, those who had at least one were significantly younger, were more likely to be male, had shorter lengths of stay, were readmitted less frequently, and were more likely to be divorced, he reported in a poster presentation at the annual meeting of the American Association for Geriatric Psychiatry.

Although the primary reason for admission could not be ascertained because of the limitations of the database, the most frequent Axis I comorbid diagnoses were recurrent major depression in 26%, bipolar disorder type 1 in 10.5%, vascular dementia in 10%, Alzheimer’s-type dementia in 7%, adjustment disorder in 7%, delirium in 5%, and generalized anxiety disorder in 3%.

Dr. Dombrowski of the University of Virginia, Charlottesville, said that these findings most likely underrepresent the problem. Although substance abuse history is routinely solicited from all new admissions, “substance abuse is likely grossly underappreciated in this population secondary to reluctance of self report, inaccuracy of self report, health care provider attitudes, and also the different social circumstances of elderly patients as compared to younger substance abusers who might be more easily identified secondary to declining occupational or social functioning,” he noted.

Moreover, there is a relative dearth of validated screening tools for identifying substance abuse in this patient population. Although they are probably underrecognized clinically, high morbidity and mortality are associated with substance abuse in the older population, including increased risk of falls, delirium, and suicide, he said.

Dr. Dombrowski has no disclosures

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