Learning objectives:

1. Recognize frequently misattributed SUD symptoms in older adults that have historically led to ineffective treatment. Identify factors that contribute to poor treatment uptake and engagement in older adults.
2. Tailor addictions care to the physical, cognitive, and psychosocial needs of older adults.
3. Deliver age-specific SUD treatment strategies for older adults from the context of an interprofessional team.
4.  

Abstract:

Background: Identification and treatment of substance use disorders (SUD) among older adults presents unique challenges. Physical and behavioral signs that are suggestive of SUD are often misattributed to the aging process or a co-morbid health condition. While addiction treatment has been shown to dramatically reduce overdose and other health risks in older adults, treatment options for this vulnerable population are limited by lack of availability, accessibility, and acceptability of services. The GRACE Project brought together an interprofessional team to deliver age-specific addictions care in an integrated outpatient setting to improve SUD recognition, treatment, and service provision to older adults. Purpose: The purpose of this research was to develop, implement, and evaluate the acceptability and effectiveness of age-specific SUD treatment for older adults in an integrated outpatient setting. Methods: Individuals aged 55+ years with SUD were invited to participate in the GRACE Project, a geriatric-focused substance use treatment clinic adapted to the physical, cognitive, and psychosocial needs of older adults. Over a 2-year period, clinical outcomes of GRACE patients were tracked and compared to an age-matched historical control group that received treatment as usual” in the context of diverse age groups. Comparative analysis using an independent t-test was conducted to detect group differences in outcomes of interest for addictions care, including treatment engagement and relapse rate. Repeated measures ANOVAs examined differences in change over time (Group x Time interactions) in clinical outcomes for diabetes, hypertension and depression among GRACE patients and age-matched historical controls. Results: As compared to an age-matched historical control group, GRACE patients (n = 39) had fewer relapses, greater treatment engagement and duration, fewer avoidable hospital admissions, and fewer instances of inappropriate use of emergency services. There was a significant Group x Time interaction for clinical outcomes related to diabetes, hypertension, and depression (p=.0001), with a significant improvement only among GRACE patients. Conclusions: Substance use disorders in older adults are most effectively addressed within the context of a patient-centered, team-based, primary care–centered model that is proactive, tailored to the unique strengths and needs of the older population, and employs a coordinated team of personnel with specific roles and special training. As a potential limitation, transition from in-person to telehealth delivery models during the COVID-19 public health emergency may have impacted GRACE patient outcomes, since the age-matched historical controls preceded the COVID-19 pandemic. Cost-benefit analysis and larger more diverse samples should be considered for future research.