General Compliance

What Can Be Done to Address Elderly Addiction? 

Written by: Tasnova Malek, MD




This article outlines the serious problem of substance abuse and addiction among our elderly. It addresses many reasons an aging population may turn to alcohol and other substances to cope with the multitude of changes involved in getting older. With opioid pain management and the resulting opioid crisis, this subject is important to consider and we are reminded it is important to not only consider the physical health of our elderly population but also their mental health. This article was submitted courtesy of Dr. Malek for educational purpose only and should not be considered consulting or legal advice.



Aging leads to a multitude of changes each person must negotiate. It brings physiological, social, and psychological changes that can lead to the misuse of alcohol or other substances in an attempt to cope. The misuse can lead to delayed diagnosis— and help for the senior.


According to the Administration for Community Living, there were approximately 54 million people aged 65+ in 2019. Of seniors 60 years and older, about 17% live with some form of substance abuse, according to an article published by Michigan State University Extension. Although, alcohol misuse is the most common substance being abused by seniors. This is concerning to the medical community because studies designed to understand how alcohol and drugs impact an aging brain are few and far between.


What is known is that the aging brain is more sensitive to the introduction of chemicals as it struggles to break down and absorb alcohol or drugs. Alcohol metabolizes slower, which allows it to accumulate in the blood quicker, leading to intoxication without someone checking on the senior's consumption.


Memory issues (like forgetting to take or doubling up on medication) may lead to unintentional misuse, while other seniors use meds to cope with loss, declining health, grief, or changes to their living situations, among other issues. In addition, drug use/misuse may impair a senior’s coordination, reaction time, or judgment, aggravating an already risky situation. Some factors that put older adults at risk for substance abuse include:

  • A previous/current mental illness
  • Social isolation
  • Financial concerns due to income changes
  • Resistance to coping with a new living environment

How to Spot Addiction in the Elderly


Health issues are a natural part of the aging process. So, it can be challenging to know if memory issues, reduced focus and low energy are by-products of getting older or symptoms of an undiagnosed substance abuse issue. Consider these warning signs:

  • Sleeping or eating habits that change
  • Moodiness and irritability
  • Erratic behavior
  • Poor hygiene
  • Unexplained bruising

Types of Substance Abuse in the Elderly


Alcohol

Alcohol abuse is the most common type of substance abuse in those over 65 years old, with 10% of seniors reporting that they binge drink, which is defined as five or more drinks on the same occasion for men, and four or more drinks on the same occasion for women.


Prescription Medicine

Because chronic health issues tend to be part of the aging process, older adults are more often prescribed potentially addictive medicines compared to other age groups. And misuse of prescription meds may exacerbate existing mental health conditions.


Opioid Pain Medicines

Persistent pain is typically another challenging condition of growing old. In fact, opioid prescriptions for pain management in older adults increased ninefold from 1995 to 2010.


Illicit Drugs

These may include the use of cocaine, or heroin, among others.


What Can Be Done to Address Elderly Addiction?


Recent data highlights the essential need to screen middle-aged as well as older adults on a regular basis. But it must include health care providers' and administrators’ efforts to develop the tools needed to work with older adults facing a debilitating addiction.


Health care professionals often mistakenly confuse substance abuse symptoms with other conditions that happen as a part of the aging process. As such, research is required to create screening methods that help detect substance abuse in older adults, which often work best with the application of coexisting medical and psychiatric conditions.


The most effective treatment and support for older adults with substance addictive issues are to leverage and coordinate the varying types of services by medical personnel (primary care physicians and addiction specialists, etc.) and community advocacy groups that support the senior community.


How to Treat Substance Use in Older Adults


There are a variety of behavioral therapies and medications that have been successful in treating substance use disorders in older adults. As noted above, there is limited research regarding the most effective model of care, although data suggest that older patients tend to have better outcomes the longer they receive the required care.


The ideal model for addressing elderly addiction includes the following –

  • Regular diagnosis
  • The management of current chronic medical conditions
  • Re-building a network of support professionals
  • Improved medical service access
  • Enhanced case management capabilities
  • Evidence-based training strategies for professionals working with seniors

The Bottom Line


There are many therapies and medications that can be used to successfully treat substance use disorders, in which many seniors respond favorably. It is never too late to choose to quit abusing any kind of substance, which, in time, will improve the future of one’s health and quality of life.

 

Additional Resources:

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Tasnova Malek, MD, graduated from Bangladesh Medical College and practiced as a primary care physician for six years in Bangladesh. After moving to the USA, she worked at Emory University Hospital in Pulmonary and Critical Care Medicine and Hospital medicine research. During COVID-19, she worked as a crisis counselor on the Florida Corona Virus Emergency Response Team. Currently, she is working in the National Suicidal Prevention Center and works reviewing articles for Sunshine Behavioral Health. In addition, she has extensive research experience in medicine and psychiatry in the USA.
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General Compliance

Primary Care and SBIRT?

Screening, Brief Intervention, & Referral to Treatment (SBIRT) Services


Written by Joanne Byron, BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, OHCC, ICDCT-CM/PCS





Detecting and implementing early intervention for your patients with non-dependent substance use is a critical part of primary care for many clinicians.  Using SBIRT can help you and your patients while getting reimbursed for these important services.


SBIRT is early intervention for individuals with non-dependent substance use to help before the individual requires more extensive or specialized treatment. This approach differs from specialized treatment for those with more severe substance misuse or a Substance Use Disorder (SUD). 


Early intervention is important and when medical records support reimbursement, you can bill for these services.

  • Medicare pays for medically reasonable and necessary SBIRT services in physicians’ offices and outpatient hospital settings.
  • Since January 1, 2020, CMS pays certified OTPs through bundled payments for OUD treatment services under Medicare Part B.
  • The patient’s medical records must support all Medicare claims.
  • States may cover SBIRT as a Medicaid state plan service.

Using SBIRT services can be manageable in primary care settings. You can systematically screen people who may not seek substance use help and offer access to SBIRT treatment services that:

  • Reduce health care costs;
  • Decrease drug and alcohol use severity;
  • Reduce risk of physical trauma; and
  • Reduce the percent of patients who go without specialized treatment.

SBIRT has 3 major components:

  • Screening;
  • Brief Intervention; and
  • Referral to Treatment.

1)  Screening

Screening is a quick, simple method of identifying patients who use substances at at-risk or hazardous levels and who may already have substance use-related disorders. The screening instrument provides specific information and feedback to the patient related to his or her substance use.


The typical screening process involves the use of a brief 1-3 question screen such as the National Institute on Alcohol Abuse and Alcoholism’s single question screen (see below under “Resources”). If a person screens positive, then a longer alcohol or drug use evaluation should be given using a standardized risk assessment tool such as AUDIT or ASSIST (references are under Resources below).


The screening and risk assessment instruments are easily administered and provide patient-reported information about substance use that any healthcare professional can easily score.


2)  Brief Intervention

Brief interventions are typically provided to patients with less severe alcohol or substance use problems who do not need a referral to additional treatment and services. In addition to behavioral health professionals, medical personnel (e.g., doctors, nurses, physician assistants, nurse practitioners) can conduct these interventions and need only minimal training. However, in cases of addiction, more intensive interventions may be needed.

  • How? Brief Intervention is a time-limited, patient-centered strategy that focuses on changing a patient’s behavior by increasing insight and awareness regarding substance use.
  • Depending on severity of use and risk for adverse consequences, a 5–10-minute discussion or a longer 20–30-minute discussion provides the patient with personalized feedback showing concern over drug and/or alcohol use.
  • The topics discussed can include how substances can interact with medications, cause or exacerbate health problems, and/or interfere with personal responsibilities.

3)  Referral to Treatment

In some cases, a more advanced treatment option is necessary and the patient is referred to a higher level of care. This care is often provided at specialized addiction treatment programs. The referral to treatment process consists of:

  • Helping patients access specialized treatment;
  • Selecting treatment facilities; and
  • Facilitating the navigation of any barriers such as cost of treatment or lack of transportation that would hinder them from receiving treatment in a specialty setting.

In order for this process to occur smoothly, primary care providers must initially establish and cultivate relationships with specialty providers, and then share pertinent patient information with the referral provider. Handling the referral process properly and ensuring that the patient receives the necessary care coordination and follow-up support services is critical to the treatment process and to facilitating and maintaining recovery.


Documenting SBIRT Services

Medicare provides documentation guidelines for the patient’s medical record.  The medical record for covered SBIRT services must:

  • Be complete and legible
  • Record start and stop times or total face-to-face time with the patient (because some SBIRT HCPCS codes are time-based)
  • Record the patient’s progress, response to changes in treatment, and diagnosis revision
  • Document the rationale for ordering diagnostic and other ancillary services or ensure it’s easily inferred

For each patient encounter, document:

  • Reason for encounter and relevant history
  • Appropriate health risk factors
  • Physical examination findings and prior diagnostic test results
  • Plan of care
  • Assessment, clinical impression, and diagnosis
  • Past and present diagnoses accessible for treating and consulting physicians
  • Date and legible provider identity
  • Signature on all services provided or ordered

Resources


CMS SBIRT Booklet 2021 (HCPCS codes, Telehealth & SBIRT and Bundled Payment Information)

Psychiatric Compliance - Short Online Course in Documentation & Coding

Screening: AUDIT Questionnaire

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