Reducing substance dependence in elderly people: the side effects program.
OBJECTIVE
To reduce benzodiazepine, narcotic and total prescription medication use in community-dwelling elderly people with suspected substance dependence.


METHODS
A community-based substance dependence program for seniors was established, and referrals were accepted from a wide variety of sources (self-referral, families, emergency departments, family physicians, community agencies, etc). The service typically included several home visits by a nurse and/or social worker trained in recognizing and treating substance dependence in the elderly, medical assessment by a geriatrician and generation of a client-directed treatment plan. Treatment plans included individual and family counselling, recommendations regarding medication changes and involvement in a peer support/education group. Medication use, health care utilization, functional status, cognition and depression scales were collected before and six months after intervention.


RESULTS
Of the 95 elderly patients with substance dependence that were seen over a period of 12 months, 55 agreed to participate in the program. Substance dependence included alcohol dependence in 23 participants, benzodiazepine dependence in 20 participants, narcotic dependence in six participants and mixed dependence in six participants. Involvement in the program was associated with significant reductions in depression scale scores (P=0.02), number of daily prescription medications (P=0.002), benzodiazepine use (P=0.01), narcotic use (P=0.04) and number of acute hospitalizations (P=0.001). No significant changes were noted in cognition, functional status, total prescription costs, office visits or emergency room visits.


CONCLUSIONS
A community-based sub- stance dependence program for elderly people may significantly reduce narcotic, benzodiazepine and prescription medication use in this population. Further studies are needed to determine the cost effectiveness of such programs.
Brymer
C
C
St Joseph's Health Care, London, Canada. cbrymer@julian.uwo.ca
Rusnell
I
I
D000203:Activities of Daily Living; D000368:Aged; D000437:Alcoholism / Q000191:economics / Q000628:therapy*; D003153:Community Health Services / Q000458:organization & administration; D003362:Cost-Benefit Analysis; D005260:Female; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011788:Quality of Life; D019966:Substance-Related Disorders / Q000191:economics / Q000628:therapy*; D016896:Treatment Outcome