Older adults with alcohol use disorder in the German addiction care system: Characterization and specific needs

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1 Older adults with alcohol use disorder in the German addiction care system: Characterization and specific needs Lisbon Addictions 2015 Barbara Braun 1, Jutta Künzel 1, Hanna Brand 1 1 IFT, Munich, Germany

2 Declaration of conflicts of interest The authors of this study declare that there is no conflict of interest. The German statistical report on in and outpatient treatment facilities for substance use disorders is funded by the German Ministry of Health. 2

3 Overview (1) Background: AUD in the elderly (2) Methods: National monitoring system of addiction care (3) Results: Outpatient sample and comparison to inpatient (4) Summary and conclusion 3

4 (1) Background Demographic change results in an aging population There is a substantial proportion of elderly with alcohol use disorders (AUD) High risk use (general population, years 1 ): males: 34%, females: 18% Elderly with AUD have elevated risk for various adverse effects: Somatic diseases: e.g. hypertension, strokes, liver disease, pulmonary diseases, bone fractures (falls) Psychological problems: e.g. depression, anxiety 1 Hapke et al,

5 (1) Background Treatment utilization: Proportion of 60+ in. 5

6 (1) Background Research questions (1) Which older adults with AUD present for treatment? (2) Do they differ from other patients other than with regard to age? (3) Are there gender specific variations? (4) Are there differences between patients with early vs. late onset of AUD? 1 Robert Koch Institut 6

7 (2) Methods National monitoring system of addiction care Design/Setting: Data collection within treatment facilities by staff members Information about patient and treatment characteristics at beginning and end of treatment (National Core Dataset) Samples (2014): All patients with main diagnosis AUD Outpatient: n=84,760 Inpatient: n=30,791 Patients aged 60+ with main diagnosis AUD Outpatient: n=8,546 Inpatient: n=2,262 7

8 (2) Methods National monitoring system of addiction care Analyses Descriptive (aggregated data) socio demographic, disorder and treatment related variables Comparison of all patients of 2014 with patients 60+: male, female; early ( 45 yrs.) vs. late (> 45 yrs) onset Outpatient and inpatient sample 8

9 (3) Results Outpatient sample: Socio demographic characteristics males 60 + females 60 + early 60+ late All patients age (m) sex male (%) relationship single (%) education > 11 yrs. (%) Inpatient sample with similar distributions 9

10 (3) Results Outpatient sample: Disorder related characteristics males 60 + females 60 + early 60+ late All patients comorbid SUD (%) benzos tobacco days consumed (last 30 days) mean age first use mean onset AUD mean Inpatient sample with similar distributions, except drinking days (16.7 vs. 16.3) 10

11 (3) Results Outpatient sample: Treatment related characteristics I males 60 + females 60 + early 60+ late All patients % first treated yes (%) referral from self familiy doctor/ psychotherapist general hospital nursing home Inpatient sample with similar distributions, except familiy referral (1.8 vs. 1.4) 11

12 (3) Results Outpatient sample: Treatment related characteristics II males 60 + females Inpatient sample with similar distributions 60 + early 60+ late All patients contacts mean treatment duration mean (weeks) treatment termination regularly (%) treatment outcome success (%) improved (%)

13 (4) Summary and conclusion Patients aged 60+ with AUD within the addiction treatment system... (1) Which older adults with AUD present for treatment? (2) Do they differ from other patients other than with regard to age? more often female, in relationship, relatively well educated low additional burden due to comorbid SUDs family and hospitals as main referral routes better treatment adherence and outcomes Exception: early onset patients: relatively similar to the whole of patients 13

14 (4) Summary and conclusion Subgroups of patients aged 60+ with AUD... (3) Are there gender specific variations? Female: more singles (and divorced, and widowed, and living alone) later first use and onset of AUD less first treatment, more family referral (4) Are there differences between patients with early vs. late onset? Late onset patients: females, high education level, later first use, less comorbid tobacco use Less self referral, highest proportion of regular treatment termination and treatment success 14

15 (4) Summary and conclusion Implications Not the classical clientele and relatively often first contact to addiction care system Positive treatment outcomes and good prognosis, especially late onset patients short interventions appropriate? self perception as not addicted? motivation for treatment goal control rather than abstinence, escpecially in case of late onset? specific / tailored interventions for likely problems of the elderly (bereavement, loneliness, loss of social functions and mobility) Special offers and/or treatment goals for female patients? e.g. groups, social activities 15

16 Thank you for your attention! 16

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