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August 2010

Facing a Growing Population of Senior Substance Abusers
Collaboration among Systems Is Key

Substance abuse among those age 60 and older, including misuse of prescription drugs, currently affects about 17 percent of this population. A study from the Substance Abuse and Mental Health Services Administration (SAMHSA) reveals that between 1992 and 2008 the proportion of substance abuse treatment admissions involving older Americans (age 50 and older) nearly doubled, from 6.6 percent of all admissions in 1992 to 12.2 percent in 2008. The study also shows a sharp rise during this period in the proportion of older Americans admissions related to illicit drug abuse, even though alcohol abuse is still the leading cause for admissions involving this age group.

Substance abuse

By 2020, the number of older adults with substance abuse problems is expected to double. The question is, as the aging network faces an ever-growing population, how do we identify and help clients who are abusing alcohol, drugs or both?

Behavioral health professionals statewide agree that substance abuse among older adults is a growing concern, but it's hard to find accurate numbers because it is a hidden problem. Substance abuse among older adults can be difficult to detect when an older person lives alone or is isolated. Friends and family may be reluctant to even consider that there may be a problem, and medical evaluations often do not reveal substance abuse. Sandy Calvert, program director for Making Prevention Work for Older Americans, reported medication and alcohol abuse in older adults is difficult to detect because it mimics the normal signs of aging and conditions commonly diagnosed in older adults, such as dementia.

Primary care physicians may not have enough information to screen their older adult clients for substance abuse. According to Minda Jaramillo, supervisor of Recovery Resources' older adult treatment program, studies show that when health professionals ask their patients about their alcohol or other drug use and explain how misuse affects their health and well-being, people with drug use disorders are much more likely to seek help. In her experience, substance abuse is something that is constantly overlooked when older adults see their primary care physicians.

Multiple systems, including those in the aging network and the behavioral health fields, have to work together to meet the needs of the older population. According to David Ross, director of Program Planning & Evaluation for the Mental Health & Recovery Board of Ashland County, the behavioral health field is pursuing ways to partner with the aging network and other systems so that older adults can get their needs met in an environment of their choice. Initiatives like "Healthy IDEAS" and the "Vial of Life" have been opportunities for collaboration in Ohio. Co-location, where behavioral health professionals work from senior centers, primary care physician's offices and other locations comfortable for seniors, is another promising solution.

He added that Ohio's various agencies and programs need to collaborate, pool knowledge, share resources and generally integrate their service delivery systems. Integration at the federal, state and local levels with regards to funding and policy would go a long way in modeling the type of collaboration needed.

Maureen Dee, executive director of Catholic Charities Services, said that serving the older population of substance abusers is all about relationships and education for consumers, the medical profession, the Aging network and behavioral health professionals. Training is needed - not just on the signs and symptoms of substance abuse, but also the levels of interventions and treatments available. Most professionals are unclear about the process for intervening, so they may be reluctant to attempt it.

Laura Kidd, director of the D. Bruce Mansfield Center, a division of Mature Services, echoed other behavioral health professionals when she said people who serve this population need to get up to speed on their specific problems. Older adults have more health problems and consume more prescribed and over-the-counter drugs than any other age group. They can have legitimate pain issues. Behavioral health professionals agree that all these issues can impact substance use disorders, and behavioral health and aging network professionals need to work together to reach an accurate diagnosis.

Programs that address the needs of older substance abusers vary from county to county. Anyone interested in the availability of substance abuse services in their county should contact the local mental health or drug alcohol board for a listing of providers.

The subject needs to be on the radar. Substance abuse is a quality of life issue. It is a treatable disease at any age. Older adults deserve treatment and they can recover. It's never too late.

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Community Small Grant Program
The Office of the Ohio Attorney General announces a Request for Proposals (RFP) for the Community Small Grant Program. Grants from $2,000 to $10,000 will be awarded for innovative projects that address local needs related to youth and families, the elderly, people with disabilities and others. Complete applications that include the cover sheet, brief program description, budget and budget narrative must be submitted online by 4 p.m. Wednesday, Sept. 15, 2010.

Assisting LIS Beneficiaries Who Lose Their Deemed Status
Many people with Medicare automatically receive Extra Help (also called the Low-Income Subsidy, LIS) because they have Medicaid, such as one of the Medicare Savings Programs (MSPs) or Supplemental Security Income (SSI). If they are no longer eligible for Medicaid, MSP or SSI, individuals may lose their deemed LIS status, despite still qualifying for Extra Help. These individuals are at risk of losing their LIS benefits if they do not successfully apply for LIS. Extra Help to Keep Extra Help: Assisting LIS Beneficiaries Who Lose Their Deemed Status, produced by the National Center for Benefits Outreach and Enrollment at the National Council on Aging (NCOA), offers promising strategies to help beneficiaries regain and retain the Medicare Part D Low-Income Subsidy.