Age-friendly care for older adults with substance use disorder.
Age-friendly care for older adults with substance use disorder.
复制标题
为患有药物滥用障碍的老年人提供老年友好型护理。
DOI：
10.1016/s2666-7568(23)00174-5
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Han,BenjaminH
中科院分区：
文献类型：
--
作者：
Jones,KatieF;Beiting,KimberlyJ;Ari,Mim;Lau-Ng,Rossana;Landi,AndreaJ;Kelly,Lauren;Pravodelov,Vassiliki;Han,BenjaminH
物质使用障碍是一种重要的、在老年人(即65岁以上)中日益普遍的疾病，不能再被认为主要是年轻人的障碍。1与年龄相关的生物、心理和社会变化，如生理变化和社会孤立，可能会增加与物质相关的伤害风险，并可能导致不健康的物质使用。在美国，包括老年人在内的吸毒过量和吸毒过量造成的死亡人数创历史新高，在2002年至2021年期间，老年人吸毒过量造成的死亡人数增加了两倍，2并且由于危险的娱乐药物供应以及治疗药物使用障碍方面的种族和社会经济不平等，对少数族裔人口造成了不成比例的影响。3尽管人们对不健康物质使用的普遍性及其相关危害的认识正在提高，但很少对老年人进行物质使用筛查，也很少向老年人提供将与物质有关的危害降至最低的方法。4成年人可能会因现有的物质使用障碍而变老，或者在以后的生活中出现新的物质使用障碍。与前几代人相比，目前世界各地的老年人群体对精神活性物质的接触更多，社会接受度也更高，这导致了以前和终身使用药物的比率更高。老年人新发的物质使用障碍可能是由精神疾病、创伤、心理社会应激源(例如，孤立、悲伤、失落和慢性疼痛或其他慢性症状)或接触处方性精神活性药物引起的。由于与年龄有关的生理变化和多发病，患有药物使用障碍的老年人面临着不成比例的与药物有关的伤害负担。衰老影响每个器官系统，最明显的是心血管、肾脏、肝脏、肌肉骨骼和神经系统。由于慢性病在这一人群中的负担增加，老年人往往更容易受到物质的不良副作用以及与物质有关的发病率和死亡率的影响。酒精和苯二氮卓类药物的使用与老年人跌倒、认知障碍和精神错乱的风险增加有关。由于老年人心血管疾病的发生率很高，兴奋剂对老年人尤其致命。此外，老年人的物质使用障碍也会恶化或促使认知障碍和虚弱等情况更早发生。6这些与年龄有关的变化可能会使许多患有药物使用障碍的老年人的初级和老年护理需求得不到满足的现实复杂化和恶化。尽管老年人中与药物有关的伤害日益普遍且风险很高，但只有不到三分之一的药物使用障碍治疗方案是为这一群体量身定做的。5随着成年人年龄的增长，药物使用障碍，由于零散的护理、运输障碍、多病和认知障碍等因素，治疗可能会变得越来越复杂。年龄歧视、与药物使用障碍诊断有关的长期耻辱以及临床医生对循证药物使用障碍护理知识的缺乏，造成了不公平的保健，并对老年人造成不成比例的伤害，老年人在医院和急性后护理设施等保健环境中花费越来越多的时间，并在两者之间过渡。6.
Substance use disorder is an important and increasingly prevalent condition among older adults (ie, over the age of 65 years), and can no longer be considered primarily a disorder of younger populations. 1 Agerelated biopsychosocial changes, such as physiological changes and social isolation, can increase the risk of substance-related harms and might drive unhealthy substance use. Drug overdoses and deaths caused by overdose, including among older adults, are occurring at record-high rates in the USA, where deaths from overdose in older adults have tripled between 2002 and 2021, 2 and disproportionately affect racially minoritised populations due to a dangerous supply of recreational drugs and to racial and socioeconomic inequities in the treatment of substance use disorder. 3 Although awareness of the prevalence of unhealthy substance use and of its related harms is increasing, older adults are rarely screened for substance use or offered approaches to minimise substance-related harms. 4 Adults can age with an existing substance use disorder or develop a new-onset substance use disorder in later life. The current worldwide cohort of older adults has had greater exposure to, and has a higher social acceptance of, psychoactive substances than earlier generations, which has been resulting in higher rates of substance use, both previous and lifelong. New-onset substance use disorder in older adults might be precipitated by mental illness, trauma, psychosocial stressors (eg, isolation, grief, loss, and chronic pain or other chronic symptoms), or exposure to prescription psychoactive medications. Older adults with substance use disorder face a disproportionate burden of drug-related harms due to age-related physiological changes and multimorbidity. Ageing affects every organ system, most notably the cardiovascular, renal, hepatic, musculoskeletal, and nervous systems. Due to the increased burden of chronic diseases in this population, older adults tend to be more vulnerable to the adverse side-effects of substances and to substance-related morbidity and mortality. The use of alcohol and benzodiazepines has been associated with an increased risk of falls, cognitive impairment, and delirium in older adults. 6 Stimulants can be particularly lethal to older adults due to the high rates of cardiovascular disease in this population. In addition, substance use disorder in older people can also worsen, or precipitate an earlier onset of, conditions such as cognitive impairment and frailty. 6 These age-related changes can complicate and exacerbate the reality that many older adults with substance use disorder have unmet primary and geriatric care needs.Despite the increasing prevalence and high risk of substance-related harms in older people, less than a third of substance use disorder treatment programmes are tailored for this population group. 5 As adults age with substance use disorder, treatment can become increasingly complex due to factors such as fragmented care, transportation barriers, multimorbidity, and cognitive impairment. Ageism, persistent stigma associated with a diagnosis of substance use disorder, and a paucity of clinician knowledge of evidence-based substance use disorder care contribute to inequitable health care and to disproportionate harms for older adults who spend increasingly more time in, and transitioning between, health-care settings, such as hospitals and post-acute care facilities. 6
DOI：
10.1016/j.hjdsi.2017.05.005
发表时间：
2018-03-01
影响因子：
2.5
作者：
Mate, Kedar S.;Berman, Amy;Fulmer, Terry
通讯作者：
Fulmer, Terry
老年人阿片类药物使用障碍的流行及其治疗：文献综述。
影响因子：
--
作者：
Jaya Sri Konakanchi;Roopa Sethi
通讯作者：
Roopa Sethi