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)

Measurement of Multidimensional Outcomes for Older Adults

Consumption levels are not the only measure of success. Other measures include:

• Drinking patterns
• Alcohol-related problems
• Physical and emotional health
• Quality of life

It is particularly important to use benchmarked methods to assess older adults to determine whether treatment regimens are effective.

Older adults have unique issues based on changes in physical functioning, changes in tolerance to alcohol, internal losses (e.g., hearing, eyesight) and external losses (e.g., death of spouse, retirement). These require a multidimensional approach to assessment and outcome evaluation to avoid relapse.

Outcome assessment is invaluable from both a management and a referral perspective. The providers of treatment, the clinicians and agencies referring patients, and patients themselves need to have information regarding likely treatment outcomes. Because treatment options range from brief interventions to structured outpatient and inpatient treatment programs, evaluation is recommended at varying points in the treatment process.¹⁷

Initial evaluation in any setting should take place at the beginning of the intervention or treatment to obtain baseline data. McLellan and Durell recommend conducting first followup evaluations 2 weeks to 1 month after the patient leaves the inpatient setting. The short timeframe reflects the need to determine if the patient is engaged in aftercare with an outpatient program to maximize the effect of inpatient treatment.

A review of the literature on patients receiving substance abuse treatment indicated that 60 to 80 percent of people who relapse do so within 3 to 4 months.¹⁸ Older adults who comply fully with and complete the intervention or treatment, however, are more likely than younger adults to positively change their drinking behavior.¹⁹ Therefore, outpatient outcomes should be assessed no sooner than 3 months and possibly as long as 12 months after treatment.¹⁷

For all types of intervention and treatment, ongoing outcome evaluation is important. The course of alcohol problems in older adults is dynamic and changes over time with circumstances. Additional life stressors can change the pattern of alcohol use in this age group.

Recently, treatment costs have increased, along with concerns about the effectiveness of alcohol treatment for both younger and older adults. Therefore, the demand to evaluate and demonstrate the quality of a variety of treatment options has grown. Outcome measurement includes methods to measure alcohol use and alcohol-related problems, physical and emotional health, and quality of life and well-being.