Substance abuse among the geriatric population is often overlooked or ignored, despite the finding that almost a fifth of older adults misuse drugs and/or alcohol (Center for Substance Abuse Treatment, 2012), and evidence showing the detrimental impact of substance abuse on elders’ quality of life. As the number of older adults in the United States increases, there is a growing demand to develop programs that can reach, recognize, and provide effective help for older adults struggling with alcohol and substance misuse and addiction.
This urgent need prompted The New Jewish Home in New York City to develop a Geriatric Substance Abuse Recovery Program (GSARP) designed to identify and support older adults with alcohol and drug misuse issues who are admitted to the organization’s skilled nursing facility (SNF) for post-acute rehabilitation following a fall, hip fracture, surgery, or other medical event.
Post-acute rehabilitation units of SNFs are uniquely positioned to serve as a gateway to alcohol and substance abuse screening and recovery for the aging population. Older adults stay in these inpatient rehabilitation settings for a period of time to regain physical strength. This length of stay gives substance abuse health professionals an opportunity to build trusting relationships with older adults in post-acute settings, and to increase the likelihood that these older adults will be willing to participate in abuse-related interventions both during their stay and upon discharge back to the community. Post-acute care is also an important intervention point because substance-use problems can interfere with successful rehabilitation. Unaddressed substance misuse, when compounded with insufficient rehabilitation, could lead to re-hospitalizations for such conditions as fall-related injuries.
The Geriatric Substance Abuse Recovery Program
The New Jewish Home created GSARP in 2014 to help identify and address alcohol- and substance-abuse issues among older adults. The program is designed to screen all incoming post-acute patients for drug and/or substance-abuse issues, and to offer a program that integrates medical rehabilitation and substance abuse counseling services for those who are identified as prospective program participants. Additionally, GSARP participants are connected to community-based substance abuse rehabilitation programs and are encouraged to attend these programs once they return home from the post-acute setting.
GSARP’s brief intervention lasts for the older adult’s entire stay in the post-acute setting. During that stay, a substance abuse counselor meets with the individual on a regular basis. Program components include:
- Identifying older adults struggling with substance abuse issues.
- Assessing the older adult’s addiction and support needs.
- Developing a comprehensive, individualized care plan to meet each person’s in-house needs during the post-acute stay. Care plans include psychology consultations, substance abuse counseling, group and individual therapy, family therapy, and community-based self-help groups, such as Alcoholics Anonymous, which meet on-site.
- Reaching out to involved family and friends and including them, with the older adult’s permission, in the rehabilitation process.
- Connecting program participants with community services before discharge to ensure continuity of the recovery process once the individual returns home.
- Developing a discharge plan with community supports, such as individual counseling, family therapy, self-help groups (Alcoholics or Narcotics Anonymous), or even in-patient substance abuse rehabilitative programs.
Efficacy of the Geriatric Substance Abuse Recovery Program
A pilot study was conducted during the first eight months of the GSARP program to examine program feasibility and efficacy (Cimarolli, Burack, Poole-Dayan, Liu, Samaroo, & Bondy, 2017). Ninety-nine (80%) of the 125 patients identified during the screening process as having drug or alcohol abuse issues agreed to participate in GSARP and 25 refused. The mean age of participants was 65 years of age; 67% were male and over 50% were minorities (28% Hispanic and 23% African American). Members of minority groups were more likely than white older adults to refuse program participation.
Among older adults who took part in the initial screening, alcohol was the most prevalent misused substance (91%), followed by illicit drugs (23%), and prescription drugs (9%). Over 20% of screened patients reported abusing more than one substance. Almost all older adults who were screened (94%) had been long-term substance abusers and a majority (72%) also had a mental health diagnosis such as depression, anxiety, or dementia.
To monitor recovery and track outcomes, program participants were called for phone interviews 30 days post discharge. Twenty-nine program participants were reached for the 30-day follow-up phone calls. One-month after discharge, 69% of telephone call participants with alcohol abuse issues, and 64% with drug abuse issues, reported that they had not relapsed. Almost three-quarters of phone call participants (73%) reported that they did not have difficulty following their discharge plan and half (50%) reported that they were continuing with Alcoholics Anonymous and/or therapy.
Participants reporting that they did not follow discharge plans listed the following reasons: lack of transportation, not understanding the discharge plan, and dissatisfaction with available community services. During the 30-day post-discharge telephone interview, 70% of participants rated their program satisfaction as “excellent” or “good.”
A new 18-month follow-up study, currently in the data-collection phase, will compare information from the medical records of GSARP participants to medical records data collected on individuals who were referred to the program but refused participation. The study is supported by a grant from the Catherine Weldon Donaghue Medical Research Foundation to The New Jewish Home, and is led by Verena R. Cimarolli, senior health services research associate at the LeadingAge LTSS Center @UMass Boston and senior research fellow at The New Jewish Home.
Guided by the Andersen Behavioral Model of Health Services Use, the study will:
- Examine whether GSARP participants have better rehabilitation outcomes when compared to GSARP refusers. The specific rehabilitation outcomes under study are improved physical functioning and likelihood of returning home as opposed to being readmitted to acute care.
- Identify individual characteristics and health behaviors associated with successful rehabilitation outcomes.
- Identify individual characteristics associated with program participation/refusal. The initial study found that the majority of patients approached about GSARP agreed to participate. However, participation rates were lower among minorities.
Further examination of factors associated with program participation may inform strategies to increase program participation, which may potentially lead to more optimal rehabilitation outcomes and, ultimately, improved quality of life of older adults with alcohol and substance misuse issues.
Margaret Bondy is Director of Social Work Manhattan Division; Orah Burack is Senior Research Associate; Irene Liu is Content Development Manager; Roberto Perez is Substance Abuse Counselor, at The New Jewish Home. Verena R. Cimarolli, PhD, is Senior Health Services Research Associate, LeadingAge LTSS Center at UMass Boston; and Gregory Poole-Dayan is Chief Operating Officer, at Wartburg Hospital.
