Substance Use Disorders in LTC

Addressing Substance Use Disorders in Long-Term Care: A Growing Need for Comprehensive Care

As the population ages, long-term care (LTC) facilities are increasingly encountering residents with complex health needs, including Substance Use Disorders (SUDs). Once considered a condition primarily affecting younger individuals, SUDs are now becoming more prevalent among older adults. This shift presents new challenges for long-term care providers who must balance the traditional care needs of older residents with the specialized treatment and support required for substance use recovery.

Understanding Substance Use Disorders in Older Adults

Substance use disorders involve the misuse of alcohol, prescription medications, or illicit drugs, and they can lead to significant physical, emotional, and social harm. For older adults, these disorders are often complicated by chronic medical conditions, mental health issues, and polypharmacy (the use of multiple medications). The aging process also alters how the body processes substances, making older adults more susceptible to the negative effects of alcohol and drugs.

In long-term care settings, SUDs may be underdiagnosed due to overlapping symptoms with other age-related conditions, such as cognitive decline or mobility issues. This makes it essential for healthcare professionals to understand potential signs of SUDs and carefully assess residents for signs of substance misuse and addiction.

Common Substances Misused in Long-Term Care

• • • Alcohol: Despite being legal, alcohol is one of the most misused substances among older adults. Excessive alcohol consumption can lead to falls, liver disease, and exacerbate other chronic conditions like diabetes or hypertension.
    • Prescription Medications: Opioids, benzodiazepines, and sedative-hypnotics prescribed for chronic pain, anxiety, or sleep disorders are frequently misused. Misuse can occur through intentional overuse or through unintentional errors, such as mixing medications with alcohol or not following dosing instructions.
    • Illicit Drugs: While less common than prescription drug misuse, older adults may still struggle with illicit drug use. With the growing acceptance and legalization of substances like cannabis, some older adults are turning to these drugs for relief from pain, anxiety, or sleep disturbances.

Challenges in Managing SUDs in Long-Term Care

Managing SUDs in long-term care facilities presents several challenges:

• • • Stigma and Underreporting: Many older adults with SUDs are reluctant to seek help due to stigma or a belief that substance use problems are a normal part of aging. As a result, they may not report their issues, leading to undetected and untreated disorders.
    • Comorbidities: Older adults often have multiple chronic health conditions, such as heart disease or diabetes, which complicate the management of SUDs. The presence of mental health conditions like depression or anxiety can further exacerbate substance use problems.
    • Polypharmacy: Managing SUDs in the context of polypharmacy is especially challenging. Long-term care residents often take several medications for various health conditions, and adding treatments for SUDs can increase the risk of drug interactions and adverse effects.
    • Limited Resources: Many LTC facilities may not have specialized staff or programs in place to treat SUDs effectively. Addiction specialists, behavioral health services, and support groups tailored to the elderly are often in short supply, leaving care teams to manage SUDs with limited resources.
    • Increased Risks and Behavioral Health Considerations: Substance use disorders can significantly heighten risks in long-term care settings, including behavioral disturbances, increased fall risk, and potential elopement. Residents with SUDs may experience cognitive impairment, mood swings, or aggression, all of which complicate care. Additionally, impaired mobility or balance due to substance use raises the likelihood of falls and related injuries. The risk of elopement (wandering away from the facility) may also increase, posing a serious safety concern for staff to manage.

Strategies for Addressing SUDs in Long-Term Care

• • • Screening and Assessment: Early detection is key to addressing SUDs in long-term care settings. Facilities should implement regular screening for substance use as part of their comprehensive assessments. Tools like the CAGE questionnaire (for alcohol use) and Screening, Brief Intervention, and Referral to Treatment (SBIRT) can be effective in identifying residents at risk.
    • Education and Training: Staff education is critical in recognizing and responding to signs of substance misuse in older adults. Training should cover the unique aspects of addiction in the elderly, including how age affects substance use and the importance of considering the resident’s full medical and mental health history.
    • Person-Centered Care Plans: Individualized care plans should address both the resident’s substance use and any co-occurring health conditions. Treatment may include medication-assisted therapy (MAT) for opioid use disorder or cognitive-behavioral therapy (CBT) for those struggling with alcohol misuse. Collaboration with addiction specialists and mental health professionals is essential for providing comprehensive care.
    • Non-Pharmacological Approaches: For managing pain and anxiety, LTC facilities can explore non-pharmacological interventions such as physical therapy, cognitive therapy, mindfulness techniques, and social support groups. These alternatives can reduce reliance on medications that carry a risk of misuse.
    • Support for Families: Family members are crucial partners in the care of residents with SUDs. Facilities should provide education and counseling services to help families understand substance use disorders and participate in the recovery process. Open communication can help alleviate concerns and provide support during challenging times.
    • Creating a Supportive Environment: Reducing the stigma around SUDs is essential in LTC settings. Encouraging open conversations about substance use and fostering an environment of understanding can help residents feel more comfortable seeking help. Support groups or peer counseling can also be beneficial for residents who may feel isolated in their struggle.

The Role of Policy and Regulation

As the prevalence of SUDs in older adults continues to grow, long-term care facilities must advocate for policies that support improved care for this population. This includes advocating for funding to train staff, increase access to addiction specialists, and implement evidence-based interventions. Additionally, collaboration with policymakers to address the challenges of prescribing opioids and other high-risk medications in LTC settings is essential.

Conclusion

Substance use disorders in long-term care require a multifaceted approach to ensure residents receive the care they need. With proactive screening, comprehensive care plans, and an environment that supports recovery, LTC facilities can effectively address the unique challenges posed by SUDs in older adults. By prioritizing education, reducing stigma, and expanding access to specialized care, long-term care providers can help residents achieve a better quality of life while partnering to assist in the management of substance use.

Join Proactive on October 9, 2024 for the next session in the LTC Behavioral Health and Psychosocial Well-Being webinar series: Substance Use Disorders to help your team grow their skills related to this important topic.