CONTENTS

Table of Contents
Introduction

1. Overview
2. Recognizing Alcohol Misuse and Abuse in Older Adults
3. Alcohol and Aging
4. Diagnosing Alcohol Problems in Older Adults
5. Recognizing Other Forms of Substance Abuse
6. Prevention and Early Intervention Strategies
7. Treatment
8. Outcomes and Cost Issues in Alcohol Treatment for Older Adults
9. Legal and Ethical Issues

Supplements
Resources

At Any Age, It Does Matter:
Substance Abuse and Older Adults (for Professionals)

Patient Placement and Patient Matching

Triage refers to the process of organizing and prioritizing treatment service. Typically, decisions regarding triage are made up of two components: patient placement and patient matching.

Patient placement describes a process by which a recommendation is made for placement in a specific level (intensity) of care. Levels range from outpatient services (low intensity) to medically managed (high intensity) inpatient services. The most commonly used patient placement criteria are found in the American Society of Addiction Medicine (ASAM) Patient Placement Criteria for the Treatment of Substance-Related Disorders, Second Edition (ASAM-PPC-2).⁵

The problems or assessment dimensions recommended by ASAM are used to make placement decisions both within and among levels of service. They are used with the general population and are not specifically geared toward older adults. Some questions, such as those related to school or work, may not apply.

These criteria should help the health care provider assess the severity of the problem and the intensity of services required. For older adults, the triage process is often greatly influenced by factors other than the severity of a drinking or prescription drug problem. For example, physical accessibility of facilities will influence treatment choices for patients in wheelchairs. Hearing-impaired patients will need programs with individual therapy and modified small group therapy.

Language barriers, illiteracy, and different cultural views of and customs surrounding substance abuse add to the factors required to assess functional abilities in older adults. To ensure optimal benefits for older adults, treatment plans should weave age-related factors into the contextual framework of the ASAM criteria.