[A version of this item appears in: Dementia: the Latest Evidence Newsletter (RWHT), Volume 2 Issue 1, August 2011].
Various psychiatric comorbidities of substance misuse are not uncommon in older people; these include intoxication and delirium, withdrawal syndromes, anxiety, depression and cognitive changes / dementia. Drug misuse can result in anxiety, depression, post-traumatic stress disorder, drug-induced psychosis, schizophrenia, delirium and dementia.
Alcohol can have a direct neurotoxic effect, resulting in “alcoholic dementia”, although some specialists dispute the validity of this controversial concept. This issue is debated by Atkinson (2002) and Gupta [and] Warner (2008).
The management of alcohol misuse in patients with cognitive impairment and / or dementia is often challenging because these patients frequently lack insight and motivation to accept help, or may be unable to engage with individual or group counselling and, even then, may be unable to retain any information supplied.
Care for patients with cognitive impairment and / or dementia is usually best provided by old age psychiatry services (with specialist input and advice from alcohol services, and possibly the general hospital where necessary). Management strategies usually involve the patient’s family, Social Services and any other (formal and informal) support networks available. The problem may be approached by the family reducing the amount of alcohol purchased or supplied to the individual.
The contents of this report comprise sections on:
- Risk factors.
- Effects and complications.
- Assessment of substance misuse in older people.
- Treatment of addiction.
- Service models: implications for service development.
- Appendix 1: Assessment of substance misuse in older people.
- Appendix 2: Guidance for pharmacological treatment of substance problems in older people.
- Appendix 3: Model alcohol misuse services for older people.
- Appendix 4: Online resources.
Working Group of the Royal College of Psychiatrists (2011). Our invisible addicts: first report of the older persons’ substance misuse. London: Royal College of Psychiatrists, June 2011. (Royal College of Psychiatrists Report CR165).