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Author List:
Mansell DL (Birmingham VAMC REAP)
Burst N (Birmingham VAMC GRECC)
Khan SA (Birmingham VAMC GRECC)
Objectives:
Geriatric substance abuse (tobacco, alcohol, prescription drug) is expected to increase as the population ages. However, clinicians often fail to suspect and evaluate geriatric patients for substance abuse. We examined rates of clinician counseling practices and patient preferences re counseling for geriatric substance abuse.
Methods:
201 consecutive consenting patients in a VA primary care faculty practice were asked about use of tobacco, alcohol, and prescription drugs (benzodiazepines, sedative/hypnotics, and narcotics) with a structured questionnaire after a clinic visit. All patients were asked about preferences for counseling for each type of substance; patients who used a substance were asked whether their clinician counseled them about use. Chi square was used to compare use of substance (yes/no) with counseling preference (yes/no).
Results:
Subjects were male (99%), white (88%), with a mean age of 74.5 (range 65 to 93). Subjects were more likely to be white (73.1% for overall clinic, p=0.04) but were similar to clinic re age and sex. 13.5% smoked, 23.5% drank, 8% drank 7+ drinks per week, 11.5% used benzodiazepines, 16.5% used sedative/hypnotics, and 33% used narcotics. Clinicians performed counseling for 84.6% of smokers, 25.5% of drinkers, 39.1% of benzodiazepine users, 24.2% of sedative users, and 21.7% of narcotic users. 76.4% of all patients wanted smoking counseling, 49.5% wanted alcohol counseling, 65.1% wanted counseling about benzodiazepines, sedatives, and narcotics. Patients who smoked were less likely to want counseling (65.2% vs. 75.1%, p=0.08), while those who used narcotics were more likely to want counseling (75% vs. 60.1%, p=0.05). Patients who used alcohol, benzodiazepines, or sedatives did not differ from those who did not re counseling preferences.
Implications:
Use of substances with abuse potential was high in this geriatric population. Most patients who used alcohol, benzodiazepines, sedatives, or narcotics were not counseled, although many wanted counseling.
Impacts:
Interventions targeted at both clinicians and patients are needed to improve care for and reduce use in geriatric substance abusers. These interventions will be even more needed as the Viet Nam veterans, who historically have had higher rates of substance abuse, age.
