Dual diagnosis in older adults: a hidden epidemic?
Creators: name: Searby, Adam
Publisher: name: RMIT University
Year: 2024
Subjects: classificationCode: 420504
subject: Mental health nursing

description: Dual diagnosis in older adults, defined as co-occurring mental ill health and alcohol and other drug (AOD) use disorders, is a poorly researched phenomenon in the older adult cohort that leads to suboptimal health outcomes, higher rates of psychiatric relapse and poor treatment engagement. Despite the recognition of the issues associated with dual diagnosis in younger mental health consumers, assessment and treatment options remain poor for their older counterparts. Likewise, few treatment settings are equipped to cater to the complexity inherent in older adults having dual diagnosis.<br><br>This thesis examines dual diagnosis in the context of an inner Melbourne community older adult mental health service, providing crisis assessment, case management and liaison services to individuals aged 65 and over. The aims of this research were to identify the prevalence of dual diagnosis in the service, describe the experiences of consumers in the service with dual diagnosis and the experiences of the clinicians providing care for them. This thesis accomplishes these aims by using an exploratory mixed methods framework, the explanatory sequential design.<br><br>The first phase of the thesis uses a file audit methodology to determine the prevalence of concurrent AOD use in individuals assessed by the community mental health service for a two-year period, June 2012-2014 (n=594). Through this process, 93 (15.5%) individuals were identified by clinicians of the mental health service to have problematic AOD use, which was recorded on a simple yes/no checkbox on an electronic assessment document. Of those recorded as using AOD, 65.2% were male and predominantly used alcohol.<br><br>The second phase of the project sought to interview consumers with dual diagnosis (n=6) who were identified by clinicians of the service as being difficult to provide care for due to their dual diagnosis. This phase identified themes of longstanding, fluid addiction careers and the notion that older adults often “adapt” their substance use as previously identified in the literature. It also identified the complexity inherent in older adults with combined mental ill health, AOD use disorders and medical conditions, highlighting the relative simplicity of the term dual diagnosis and its applicability in the older adult cohort.<br><br>The final phase of the project interviewed clinicians of the mental health service (n=10) to determine their experiences of providing care for older adults with dual diagnosis. The interview schedule for this phase was informed by both the initial phase of the research and the results of the consumer interview process. This phase identified the frustration evident in caring for older adults with dual diagnosis, and highlighted poor knowledge and inconsistent assessment techniques. The lack of perceived progress in this consumer cohort also led to a feeling of clinical helplessness, ending in therapeutic nihilism where it was felt that nothing could be done to change longstanding patterns of AOD use.<br><br>As an exploratory study, this thesis identifies a number of substantial issues in the care provided to older adults with dual diagnosis, and acts as a strong foundation study to inform future research into this cohort. Assessment of older adults with AOD use was found to be poor, with clinicians reporting poor service linkages and difficulty in identifying appropriate treatment options for older adults with dual diagnosis in their care. This thesis makes a number of recommendations for service improvement and future research, including implementing enhanced assessment, exploring wider populations of older adults with dual diagnosis and policy changes.<br><br>Older adults with AOD use disorders have been labeled as “invisible addicts” in the media due to poor assessment and recognition of AOD use in this cohort. This thesis adds support to this argument, identifying poor assessment and service provision to older adults with both mental ill health and AOD use disorders. Given demographic changes in Australia, which include the ageing baby boomer cohort, the time to investigate and implement improved care to older adults is imperative to avoid a hidden epidemic.