Seniors with substance abuse problems
Seacoast Mental Health identifies 'invisible' population
Portsmouth Herald - 9/10/2017
PORTSMOUTH - While there is much talk about the opioid crisis in the state, and across the nation, one affected population is largely invisible in the discussions.
Senior citizens represent a large chunk of the people being prescribed, and using, narcotic pain relievers. Also, the isolation of much of the elderly population is contributing to depression and alcoholism.
Jennifer Kinsey is a licensed therapist and is the director of the REAP (Referral, Education, Assistance and Prevention) program for Seacoast Mental Health Services in Portsmouth. REAP is a statewide outreach program for older adults, over the age of 60. It offers services to people who are residents of senior housing sites regardless of age.
"Older adults are often on pain medications," said Kinsey. "Sometimes they are taking them as prescribed and have problems. Sometimes they may not be using them correctly and having more problems."
Adding to that, Kinsey said, often relatives, friends, even caregivers are exploiting them for their medications. Or, older people have children with substance abuse issues and they are finding themselves in the position of raising their grandchildren.
"The problem is often made worse by the fact that this is a proud generation who does not readily ask for help," said Kinsey. "I have already lost two in my practice, people over the age of 50, to opioids. Then there are those people living in senior housing and abusing alcohol. They are depressed and self-medicating. We found out quickly that they are not coming to services seeking help."
Kinsey said REAP counselors help with issues surrounding alcohol use, medication management, depression and mental health concerns for seniors who choose to remain living independently. The services are free and confidential, through blended funding from four state agencies: the Housing Finance Authority, the Bureau of Drug and Alcohol Services, the Bureau of Elderly and Adult Services and the Bureau of Behavioral Health.
The REAP program was developed and designed by N.H. Housing and Finance Authority, in 1992. NHHFA continues to provide substantial funding in collaboration with the state of N.H. Department of Health and Human Services. It is a statewide program but SMHS holds the contract to manage it.
Alcohol and drug abuse in older adults is often closely linked to mental health issues, Kinsey said.
"We see 2,000 to 4,000 people a year in our programs," said Kinsey. "We get referrals from family members, primary care doctors, hospitals, nurses, emergency responders and the police. We see a lot of early dementia that comes with depression, anxiety and substance abuse. Many of the older adults are estranged from their families so there are not a lot of eyes on them."
Another problem Kinsey says needs to be addressed is medication management.
"Maybe these people have a pain prescription or a psych medication," said Kinsey. "Many older adults are on multiple medications and some meds may be amplifying others. It is not intentional on the person's part, but it is happening."
Kinsey said she would like to see a method for doctors or pharmacists to help older people better manage their medications.
"Family members, if they are around, can advocate for the person," said Kinsey. "They can ask the hard questions. Many older people have a hard time questioning their doctor. Caregivers can help. They see what is happening on a daily basis. If there are concerns, let the doctor know what is happening."
"I have a client on pain meds for back pain," said Kinsey. "She seems like a stoner. I have seen people get control of their medications and clarity comes back into their lives. With the proper support, older adults can do very well and remain independent for a long time."