Assessment issues
It is important that routine questions about substance use are included in all assessments with older people.  However, before beginning an assessment of an older person’s substance use it is important to consider the following issues that may have an impact on the assessment:

• Older people may find it harder to discuss their alcohol or drug use, particularly if they have come from a generation where alcohol and drugs were not so readily available.  They may be greatly embarrassed by the stigma attached to any problems they are experiencing as a result of substance use.
• Cultural factors are important as cultural norms and identity may have an impact on whether, and how, people discuss their substance use.  Similarly the impact of cultural norms and language differences on the communication and assessment process need to be considered.
• The setting of the assessment needs to be considered in terms of accessibility and to minimise embarrassment and stigma.
• Relatives or other carers, eg. home helps or domiciliary care, can be helpful in terms of information on the person’s substance use and behaviour generally.  Ask your client for permission to speak to them as part of your assessment.

Everyone’s physiology changes through the ageing process and, for older people, these changes need to be considered, in terms of the assessment and treatment of substance problems.  Key points to consider include:

• Some physical health problems resulting from alcohol or drug misuse could be overlooked and attributed to other aspects of ageing or age-related conditions, eg. confusion, falls, depression, poor nutrition
• The way the body processes drugs or alcohol will be determined by the condition of the individual’s organs, weight, size, body fat ratio and so on.  Older age usually means longer use of the body and potential weaknesses in some physiological functions, eg. reduced kidney or liver function.  Alcohol and drugs can therefore be more concentrated at lower levels of consumption.
• Is the person inadvertently misusing over the counter drugs, due to poor memory or other cognitive problems

In assessing an older person’s drug or alcohol use the following questions may help in addition to an assessment of their substance use:

• What are their pre-existing medical problems?
• Do any existing medical conditions make the person more vulnerable to the negative impact of alcohol or drugs?
• Is a ‘medicinal tote’ of alcohol added to tea or coffee – if so how much exactly and how often?
• Do they have a drink before bed to ‘help them sleep’ – if so what size is the drink?
• What medications are they on and what is the likely impact of mixing alcohol or other drugs with their medication?  Do they understand this impact?
• Have you considered that the person’s drug or alcohol use might be mistaken for conditions relating to ageing?

s with all assessments of substance use, the assessment of older people needs to be holistic - not just focussed on the substance.  It may be there are other areas or priorities for that person that need addressing first, eg. loneliness, boredom etc.  These may, in turn, help reduce any problematic substance use.