A review of existing treatments for substance abuse among the elderly and recommendations for future directions.
A review of existing treatments for substance abuse among the elderly and recommendations for future directions.
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DOI：
10.4137/sart.s7865
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Sacco P
中科院分区：
文献类型：
--
作者：
Kuerbis A;Sacco P
随着人口老龄化，人们普遍认识到，医疗保健系统必须准备好服务于物质使用老年人（OA）在未来几十年的独特需求。因此，越来越迫切需要为OA确定有效的药物滥用治疗（SAT）。尽管有这样的需求，但是对于骨关节炎治疗的研究仍然少得惊人。这篇综述描述和评估了过去30年来应用于OA和专门为OA设计的SAT研究，重点是使用的方法和获得的知识。使用三个研究数据库，回顾了过去30年发表的25项研究，这些研究调查了SAT对OA的影响，并符合特定的选择标准。大多数研究在方法上是有限的，因为它们只是测试前后或测试后的研究。在随机对照试验中，许多试验受限于每组15人或更少的样本量，因此很难发现主要效应。因此，谨慎地说，文献表明，在寻求OA的治疗中，无论是特定年龄还是混合年龄的治疗，通常都能产生与普通人群和年轻人群相当的戒断率。研究还表明，无论护理水平如何，越大的治疗暴露（剂量越高），OA的疗效越好。最后，仅基于两项研究，年龄特异性治疗似乎增强了OA的治疗效果。像年轻人一样，OA似乎对治疗有异质反应，初步证据表明OA可能有治疗匹配。为了最大限度地提高医疗服务系统的有效性和效率，迫切需要扩大OA的SAT研究。未来的研究需要包括实验室和社区为基础的随机对照试验，这些试验具有较高的内部有效性，包括动机性访谈、认知行为疗法和纳曲酮等药物，以确定OA的最佳治疗方案。
With population aging, there is widespread recognition that the healthcare system must be prepared to serve the unique needs of substance using older adults (OA) in the decades ahead. As such, there is an increasingly urgent need to identify efficient and effective substance abuse treatments (SAT) for OA. Despite this need, there remains a surprising dearth of research on treatment for OA. This review describes and evaluates studies on SAT applied to and specifically designed for OA over the last 30 years with an emphasis on methodologies used and the knowledge gained. Using three research databases, 25 studies published in the last 30 years which investigated the impact of SAT on OA and met specific selection criteria were reviewed. A majority of the studies were methodologically limited in that they were pre-to-post or post-test only studies. Of the randomized controlled trials, many were limited by sample sizes of 15 individuals or less per group, making main effects difficult to detect. Thus, with caution, the literature suggests that among treatment seeking OA, treatment, whether age-specific or mixed-age, generally works yielding rates of abstinence comparable to general populations and younger cohorts. It also appears that with greater treatment exposure (higher dosage), regardless of level of care, OA do better. Finally, based on only two studies, age-specific treatment appears to potentiate treatment effects for OA. Like younger adults, OA appear to have a heterogeneous response to treatments, and preliminary evidence suggests a possibility of treatment matching for OA. Expansion of research on SAT for OA is urgently needed for maximum effectiveness and efficiency of the healthcare system serving these individuals. Future research needs to include laboratory and community based randomized controlled trials with high internal validity of previously vetted evidenced-based practices, including Motivational Interviewing, cognitive behavioral therapy, and medications such as naltrexone, to determine the best fit for OA.