scholarly journals RURALITY, ALCOHOL, AND OPIOID USE AS PRECURSOR TO ELDER ABUSE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S762-S763
Author(s):  
Faika Zanjani
Keyword(s):  
Older Adults ◽  
Risk Management ◽  
Substance Use ◽  
Health Professionals ◽  
Rural Areas ◽  
Community Education ◽  
Elder Abuse ◽  
Adult Population ◽  
Dissemination And Implementation ◽  
Opioid Use

Abstract Pain, alcohol, and opioid risk management is an increasingly important issue in the care of the older adult population. Older adults are at higher risk for pain and the negative outcomes associated with opioid and alcohol use due to higher prevalence of multimorbidity, polypharmacy, and the age-associated changes in metabolism and elimination. Evidence-based approaches for pain and substance use management exist and are effective for older adults, but underutilized and have limited availability in rural areas. Therein, undermanagement of pain and substance use becomes a risk factor for elder abuse. Improved dissemination and implementation in practice, as well as training for health professionals and the community is needed to better realize and prevent negative health outcomes from pain, alcohol, and opioid use. Community education and training tools for health professionals will be discussed, with suggestions for community initiatives to address pain, alcohol, and opioid risk management to prevent elder abuse.

Barriers and Facilitators of Using Telehealth to Identify and Manage Behavioral Health and Substance Use Disorder Conditions in Rural Areas: An Environmental Scan (Preprint)

2020 ◽  
Author(s):  
Naim Naim ◽  
Laura Dunlap
Keyword(s):  
Substance Use ◽  
Behavioral Health ◽  
Substance Use Disorder ◽  
Rural Areas ◽  
Primary Care Providers ◽  
Care Patient ◽  
Direct Patient Care ◽  
Care Providers ◽  
Provider Education ◽  
Opioid Use

BACKGROUND Access to behavioral health services, particularly substance use disorder (SUD) treatment services, is challenging in rural and other underserved areas. Some of the reasons for these challenges include local primary care providers without experience in behavioral health treatment, few specialty providers, and concerns over stigma and lack of privacy for individuals from smaller communities. Telehealth can ease these challenges and support behavioral health, specifically SUD treatment, in a variety of ways, including direct patient care, patient engagement, and provider education. Telehealth is particularly relevant for the growing opioid epidemic, which has profoundly affected rural areas. OBJECTIVE We sought to understand how telehealth is used to support behavioral health and SUDs, with a particular focus on implications for medication-assisted treatment for opioid use disorders. The intent was to understand telehealth implementation and use, financing and sustainability, and impact in the field. The results of this work can be used to inform future policy and practice. METHODS We reviewed literature and interviewed telehealth stakeholders and end users in the field. The team identified a diverse set of participants, including clinical staff, administrators, telehealth coordinators, and information technology staff. We analyzed research notes to extract themes from participant experiences to answer the study questions. RESULTS Organizations varied in how they implemented telehealth services and the services they offered. Common themes arose in implementation, such as planning for technical and organizational impacts of telehealth, the importance of leadership support, and tailoring programs to community needs. CONCLUSIONS Telehealth is used in a variety of ways to expand access to services and extend service delivery. As the policy and reimbursement landscape continues to evolve, there may be corresponding changes in telehealth uptake and services provided. CLINICALTRIAL NA

scholarly journals Low Back Pain and Substance Use: Diagnostic and Administrative Coding for Opioid Use and Dependence Increased in U.S. Older Adults with Low Back Pain

Pain Medicine ◽  
2021 ◽  
Author(s):  
Beth B Hogans ◽  
Bernadette C Siaton ◽  
Michelle N Taylor ◽  
Leslie I Katzel ◽  
John D Sorkin
Keyword(s):  
Older Adults ◽  
Substance Use ◽  
Low Back Pain ◽  
Back Pain ◽  
National Sample ◽  
Cross Sectional Study ◽  
Diagnostic Code ◽  
Low Back ◽  
Opioid Use ◽  
Cross Sectional

Abstract Objective Low back pain (LBP) is a leading cause of pain and disability. Substance use complicates the management of LBP, and potential risks increase with aging. Despite implications for an aging, diverse U.S. population, substance use and LBP comorbidity remain poorly defined. The objective of this study was to characterize LBP and substance use diagnoses in older U.S. adults by age, gender, and race. Design Cross-sectional study of a random national sample. Subjects Older adults including 1,477,594 U.S. Medicare Part B beneficiaries. Methods Bayesian analysis of 37,634,210 claims, with 10,775,869 administrative and 92,903,649 diagnostic code assignments. Results LBP was diagnosed in 14.8±0.06% of those more than 65 years of age, more in females than in males (15.8±0.08% vs. 13.4±0.09%), and slightly less in those more than 85 years of age (13.3±0.2%). Substance use diagnosis varied by substance: nicotine, 9.6±0.02%; opioid, 2.8±0.01%; and alcohol, 1.3±0.01%. Substance use diagnosis declined with advancing age cohort. Opioid use diagnosis was markedly higher for those in whom LBP was diagnosed (10.5%) than for those not diagnosed with LBP (1.5%). Most older adults (54.9%) with an opioid diagnosis were diagnosed with LBP. Gender differences were modest. Relative rates of substance use diagnoses in LBP were modest for nicotine and alcohol. Conclusions Older adults with LBP have high relative rates of opioid diagnoses, irrespective of gender or age. Most older adults with opioid-related diagnoses have LBP, compared with a minority of those not opioid diagnosed. In caring for older adults with LBP or opioid-related diagnoses, health systems must anticipate complexity and support clinicians, patients, and caregivers in managing pain comorbidities. Older adults may benefit from proactive incorporation of non-opioid pain treatments. Further study is needed.

scholarly journals Older Adults and Opioid Education: Lessons Learned From Experiences in Rural Arkansas

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 54-54
Author(s):  
Robin McAtee ◽  
Leah Tobey ◽  
Corey Hayes ◽  
Laura Spradley ◽  
Sajni Kumpuris
Keyword(s):  
Older Adults ◽  
Pain Management ◽  
Rural Areas ◽  
Term Treatment ◽  
Lessons Learned ◽  
Opioid Use ◽  
Farm Bureau ◽  
Department Of Health ◽  
Long Term Treatment ◽  
Agricultural Areas

Abstract Nearly one-third of all Medicare participants were prescribed an opioid by their physician in 2015 (AARP, 2017) and in 2017, Arkansas had the 2nd highest opioid prescribing rate in the nation (CDC, 2019). Approaching older adults (OA) about opioids and pain management can be a sensitive topic. Educating and altering long-term treatment with opioids is especially challenging in rural areas where literacy, especially health literacy, is suboptimal. The Arkansas Geriatric Education Collaborative (AGEC) is a HRSA Geriatric Workforce Enhancement Program with an objective to improve health outcomes including an emphasis to decrease the misuse and abuse of opioids among older Arkansans. To address this crisis, the AGEC partnered with local leaders such as the AR Drug Director, academia, Department of Health and Human Services, and multiple community based organizations to create age-tailored educational programs. Unique aspects of approaching and educating rural OA about opioids and pain management will be reviewed. Outcomes will be discussed such as their lack of knowledge about: what is an opioid, why they were prescribed, and what are viable alternatives. Also discussed will be lessons learned that resulted in more effective methods of reaching and teaching rural OA. Partnering with the AR Farm Bureau helped the AGEC reach 100’s of farmers in the extremely rural and mostly agricultural areas. Learning to not use the word opioid resulted in more participants and in a more positive attitude and outlook on attempts to change the culture of opioid use, misuse and abuse among older Arkansans.

scholarly journals ELDER ABUSE AMID THE OPIOID EPIDEMIC: APS CASES IN RURAL AMERICA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S763-S763
Author(s):  
Pamela B Teaster ◽  
Karen A Roberto ◽  
Jyoti Savla
Keyword(s):  
Older Adults ◽  
Elder Abuse ◽  
Standard Errors ◽  
Opioid Misuse ◽  
Rural America ◽  
Opioid Use ◽  
Care Needs ◽  
Community Based ◽  
Community Based Services ◽  
Physical Care

Abstract Older adults are hidden victims of the opioid crises, suffering abuse at the hands of those who seek resources to support their addiction. Using APS data from 2015-2017 provided by the Kentucky Department for Community-Based Services, we used a logistic regression model with robust standard errors to examine whether substantiated cases of elder abuse were associated with opioid misuse by perpetrators. Overall, 9% of the 462 substantiated cases over the three-year period involved perpetrators were substance users. The percentage of these cases rose from 5% in 2015 to 13% in 2016 before dropping to 7% of elder abuse cases in 2017. Opioid use was most prevalent among perpetrators of financial abuse of older adults with cognitive and/or physical care needs. The current study offers a first look at empirical linkages between opioid misuse and elder abuse and revealed consistencies across cases that call for further investigation.

scholarly journals Age-Friendly Online Training Programs for Long-Term Services and Supports Staff to Improve Care for Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 532-532
Author(s):  
Linda Edelman ◽  
Kara Dassel
Keyword(s):  
Older Adults ◽  
Rural Communities ◽  
Rural Areas ◽  
Urban Areas ◽  
Online Training ◽  
Team Leadership ◽  
Educational Opportunities ◽  
Opioid Use ◽  
Term Care

Abstract The purpose of our Geriatric Workforce Enhancement Program is to provide geriatric and primary care education and training to long-term care (LTC) providers and staff, health professions students and community members. Our LTC partners and the communities we serve are often very rural and travel to urban areas for training can be difficult. Therefore, we have developed four online training that are offered free to our partners and rural communities statewide. These programs are designed to integrate the aims of the Age-Friendly 4M’s model (i.e., What Matters, Mobility, Medication, Mentation). The LTC nurse residency program provides gerontological nursing and inter-professional leadership training (all 4M’s), in a synchronous online environment. The asynchronous Alzheimer’s Disease and Related Dementias training modules educate LTC staff and family caregivers about types, diagnosis and care of older adults with dementia (Mentation and Medication). The asynchronous Opioid Use in LTC modules were developed with partners to deliver live at LTC staff trainings about opioid stewardship (Medication). The LTC Learning Communities are monthly tele-health sessions for inter-professional LTC teams to discuss current issues and propose solutions (all 4M’s). We have successfully leveraged different synchronous and asynchronous online modalities to increase educational opportunities for formal and informal caregivers, including those in rural areas whose educational opportunities are geographically limited. To date our programs have reached over 500 individuals across our state, increasing knowledge about geriatric concepts, communication and team leadership. Moving forward, we will continue to develop and refine educational programs that promote the Age-Friendly geriatric-focused health care.

scholarly journals In the Eye of the COVID-19 Storm: An Ethical Analysis on Aging, End of Life, and Recovery

2021 ◽  
Vol 9 (5) ◽  
Author(s):  
Al Giwa
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Elder Abuse ◽  
Adult Population ◽  
Severe Disease ◽  
Multiple Chronic Conditions ◽  
Geriatric Population ◽  
Term Care ◽  
Medical Response ◽  
Older Adult Population

Early into the COVID pandemic, epidemiologists and infectious disease experts warned that older adults were among those most vulnerable to the disease, as multiple studies from China, Italy, Washington State, and New York City showed that age greater than 65 significantly increased the risk of severe disease and/or death from the novel 2019 coronavirus. Centers for Disease Control data through June 2020 show that nearly 81% of deaths due to COVID-19 are of people 65 years of age and older. These breakdowns indicate that, primarily, persons with advanced age and most, often, those with multiple chronic conditions are those who have died. The effects of the virus led to public health measures aimed at reducing exposures of older people and other vulnerable populations. The disease was amplified in rehabilitation centers, skilled nursing facilities, assisted living centers, group homes, and other long-term care facilities serving a primarily geriatric population. Even as parts of the country are opening up, the death toll is still climbing and affecting the older adult population disproportionately. Duty to care, autonomy and self-determination, non-judgmental regard, justice, and futility are all significant ethical principles and constructs that have arisen in the intense and real-time application of healthcare as we continue to face the present global pandemic. We use an ethical lens to examine the medical response of the SARS-CoV-2 pandemic on the older adult population and explore if society is doing enough to protect older adults, or rather, engaging in and furthering collective and systematic elder abuse.

Rural Postpartum Women With Substance Use Disorders

2018 ◽  
Vol 28 (9) ◽  
pp. 1449-1461 ◽  
Author(s):  
Debra Kramlich ◽  
Rebecca Kronk ◽  
Lenora Marcellus ◽  
Alison Colbert ◽  
Karen Jakub
Keyword(s):  
Substance Use ◽  
Rural Women ◽  
Rural Areas ◽  
Participant Observation ◽  
Care Service ◽  
Geographic Location ◽  
The United States ◽  
Care Providers ◽  
Opioid Use ◽  
Emotional Safety

The incidence of perinatal opioid use and neonatal withdrawal continues to rise rapidly in the face of the growing opioid addiction epidemic in the United States, with rural areas more severely affected. Despite decades of research and development of practice guidelines, maternal and neonatal outcomes have not improved substantially. This focused ethnography sought to understand the experience of accessing care necessary for substance use disorder recovery, pregnancy, and parenting. Personal accounts of 13 rural women, supplemented by participant observation and media artifacts, uncovered three domains with underlying themes: challenges of getting treatment and care (service availability, distance/geographic location, transportation, provider collaboration/coordination, physical and emotional safety), opportunities to bond (proximity, information), and importance of relationships (respect, empathy, familiarity, inclusion, interactions with care providers). Findings highlight the need for providers and policy makers to reduce barriers to treatment and care related to logistics, stigma, judgment, and lack of understanding of perinatal addiction.

scholarly journals ADDRESSING OLDER ADULT SOCIAL ISOLATION AND ABUSE THROUGH RURAL OUTREACH AND INTER-ORGANIZATIONAL COLLABORATION

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S59-S59
Author(s):  
Naomi R Meinertz ◽  
Megan Gilligan ◽  
Jeongeun Lee ◽  
Louise Peitz
Keyword(s):  
Older Adults ◽  
Rural Communities ◽  
Focus Groups ◽  
Social Isolation ◽  
Rural Areas ◽  
Service Providers ◽  
Elder Abuse ◽  
Direct Care ◽  
Increased Risk ◽  
Organizational Collaboration

Abstract Elder abuse is commonly linked with social isolation and in a rural state, such as Iowa, older adults may be at increased risk of social isolation and elder abuse. A community-based needs assessment aimed to record the first-hand perspectives of service providers regarding the needs of older adults in rural areas across the state of Iowa, covering 54 of the 99 counties. Through a survey (N=202) and focus groups (N=24), service providers, including direct care, Area Agencies on Aging, law enforcement, and attorneys, offered ways in which to address the gaps in service provision and prevention of elder abuse. Based on survey and focus groups, suggestions included ways to decrease social isolation among older adults by improving service outreach, provider training, and inter-organization communication. Discussion will outline gaps in service outreach and address future inter-organizational collaboration and strategies to prevent social isolation and elder abuse in rural communities.

scholarly journals Elder Abuse and Neglect: Training First Responders in Rural Arkansas to Recognize, Respond, and Report

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 46-47
Author(s):  
Robin McAtee ◽  
Valerie Claar ◽  
Laura Spradley ◽  
Whitney Thomasson
Keyword(s):  
Older Adults ◽  
Police Officers ◽  
Rural Areas ◽  
Elder Abuse ◽  
First Responders ◽  
Elder Abuse And Neglect ◽  
Abuse And Neglect ◽  
Potential Abuse ◽  
On Line ◽  
Type Of Abuse

Abstract As the incidence of elder abuse and neglect continue to rise and plague our country’s older adults, it is imperative that their plight is recognized, reported and elicits an appropriate response. At least 1 out of 10 older adults suffer from at least one type of abuse each year (DOJ, 2020) and only 1 in 24 cases of elder abuse is ever reported to authorities (National Center on Elder Abuse, 2019). Since 41% of Arkansas’ population live in rural areas, reaching and educating first responders who work in these areas is a priority, yet has been a challenge. It has been ascertained that virtually no elder abuse or neglect related training for first responders occurs in Arkansas. In 2015, the Arkansas Geriatric Education Collaborative (a HRSA Geriatric Workforce Enhancement Program) developed an education program and mobilized it to multiple first responder groups including the AR State Police, multiple city and county paramedics’ organizations, EMTs, local police officers and fire fighters. The program was further enhance late in 2019 when the training was made available on-line in conjunction with dementia training. The content and methods of training and test results revealing knowledge gained will be reviewed. Follow-up stories from first responders who have put their training into action in the field will be told as they reveal how they have used their training to identify potential abuse, neglect and self-neglect cases and how they have recognized, reported and addressed specific cases.

scholarly journals Relationship between chewing tobacco, smoking, consuming alcohol and cognitive impairment among older adults in India: a cross‐sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
T. Muhammad ◽  
Manideep Govindu ◽  
Shobhit Srivastava
Keyword(s):  
Older Adults ◽  
Substance Use ◽  
Cognitive Impairment ◽  
Alcohol Consumption ◽  
Smokeless Tobacco ◽  
Rural Areas ◽  
Urban Areas ◽  
Chewing Tobacco ◽  
Sample Distribution ◽  
Explanatory Variables

Abstract Background Physical aging increases the sensitivity to the effects of substance use, elevating the risk for cognitive impairment among older adults. Since studies on the association of substance use with cognitive ability in later years are scant in India, we aimed to explore the factors associated with cognitive impairment especially, alcohol consumption, smoking, and chewing tobacco later in life. Methods The present research used nationally representative data from Building a Knowledge Base on Population Aging in India (BKPAI) that was conducted in 2011, across seven states of India (N=9,453). Sample distribution along with percentage distribution was calculated for cognitive impairment over explanatory variables. For finding the association between cognitive impairment over explanatory variables, binary logistic regression models were estimated. Results About 16.5 percent of older adults in rural areas consumed smoked tobacco compared to 11.7 percent in urban areas. Nearly, 23.7 percent of rural older adults consumed smokeless tobacco in comparison to 16 percent in urban areas. Alcohol consumption was high among rural residents (7.9%) than urban counterparts (6.7%). The prevalence of cognitive impairment was 62.8% and 58% among older adults from rural and urban areas respectively. Older adults who smoked tobacco had a 24 percent significantly higher likelihood to have cognitive impairment with reference to older adults who did not smoke [OR: 1.24, CI: 1.02-1.49]. Moreover, older adults who consumed alcohol had a 30 percent significantly higher likelihood to have cognitive impairment [OR: 1.02, 1.65]. It was also found that older adults who had smoked along with consuming alcohol were at risk of worse cognitive outcomes than those who neither smoke nor drink alcohol [OR: 1.56, CI: 1.21-2.00] or consumed either of them unlike consuming smokeless tobacco only. Conclusion The encouragement of older people to stop smoking and smokeless tobacco use could be considered as part of a strategy to reduce the incidence of cognitive impairment. Further, appropriate measures should be taken for the detection of early stages of cognitive decline in older individuals and efforts should be made to improve the availability and quality of care for dementing older adults.

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