By Geralyn Magan
LTSS Center researchers are taking a close look at the Geriatric Substance Abuse Recovery Program at The New Jewish Home, a LeadingAge member in New York.
Older New Yorkers receive an unusual invitation when they arrive at The New Jewish Home in Manhattan for short-term rehabilitation after a hip replacement or other hospital treatment. Would they like to be screened for issues associated with alcohol or prescription drug use?
If the screening uncovers a substance use issue, the older adult is then invited to enroll in the Geriatric Substance Abuse Recovery Program (GSARP). For the remainder of the post-acute stay, the individual receives substance abuse counseling alongside the physical and occupational therapy that brought him or her to The New Jewish Home in the first place.
The 3-year-old GSARP has already been shown to be effective in helping participants address their substance abuse issues. A 2016 study by the Research Institute on Aging at The New Jewish Home found that during 2 follow-up points after rehab, at least 60% of GSARP participants reported that they had not relapsed.
Now, a new study by the LeadingAge LTSS Center @UMass Boston will explore whether, in addition to helping address substance abuse issues, GSARP might also improve rehabilitation outcomes for program participants.
During the 18-month study, supported by a grant from the Catherine Weldon Donaghue Medical Research Foundation, researchers will also be trying to understand the characteristics and health behaviors of GSARP participants who are most likely to have successful post-acute care outcomes. In addition, they’ll be assessing the characteristics of individuals who are most likely to participate—or refuse to participate—in the program.
BACKGROUND
About 17% of older adults in the U.S. have alcohol and/or drug use issues, according to Dr. Verena Cimarolli, senior health services research associate at the LTSS Center. Cimarolli led the 2016 study of GSARP for The New Jewish Home, and is leading the current study for the LTSS Center.
In a 2018 Educational Gerontology article summarizing the findings of the 2016 study, Cimarolli and her co-authors cited statistics indicating that alcohol and drug misuse can have a “profound negative impact” on the health of older adults. Physiological changes in how the body processes alcohol and drugs put older adults at greater risk for substance misuse-related problems, including:
- Intoxication-related accidents, falls, and related injuries;
- Dangerous interaction with prescribed drugs that can lead to greater risk for hospital admission and readmission; and
- Increased risk of infection, heart disease, cancer, and mental health issues.
Despite the prevalence and health risks of substance abuse among older adults, however, the article’s authors characterized substance misuse among older adults as “under-acknowledged and under-identified for decades.”
THE INTERVENTION
The GSARP intervention lasts for as long as the individual’s fixed length of stay in rehab. During that stay, a substance abuse counselor meets with the individual on a regular basis.
“This is a counseling and referral program, not a treatment program,” says Cimarolli. “It is designed to help participants become more aware of their substance abuse issues, to set them up with treatment programs in the community, and to make it more likely they will connect with those programs after they return home.”
Offered free of charge, GSARP is designed to engage with individuals at a time in their lives when they are most likely to accept help. Prospective program participants already are receiving help with a physical need, so they may be more likely to accept additional help, explains Cimarolli. In addition, they are living in a post-acute setting where the common barriers to seeking substance abuse counseling—including lack of funds and transportation—do not exist.
“Oftentimes, the issues they are having in terms of the physical rehab may stem from alcohol misuse,” says Cimarolli, citing a 2017 New York Times article about substance abuse among older adults. “When someone has a substance misuse issue, they are more likely to fall, to break a hip, to be admitted to the hospital, and then to be transferred to rehab. The rehab setting is a really good time to intervene by bringing up a topic that no one wants to talk about.”
Not intervening at this point could represent a missed opportunity for nursing homes, says Cimarolli.
“Typically, people in the program have a long history of alcohol issues, and it really impacts their health and increases the risk of accidents and injury,” says Cimarolli. “When the substance abuse issue behind the accidents is not addressed, then the same people may keep coming back to rehab. But when nursing homes help older adults address these underlying misuse issues, they can possibly prevent those readmissions, and really help their post-acute patients.”
THE LTSS CENTER STUDY
LTSS Center researchers will spend the next 18 months exploring several aspects of the GSARP intervention, including:
- Outcomes: Researchers will examine whether GSARP participants have a more successful rehab experience as a result of the substance use intervention. “We’re assuming that someone getting these extra supports would do better in rehab,” says Cimarolli. “But we don’t know. That’s why we are doing the study.”
- Participation: The study will also explore how personal characteristics and health behaviors influence a person’s willingness to participate in the GSARP program, or their choice to refuse participation. “We found, for example, that minorities are less likely to take advantage of the program,” says Cimarolli. “One of the aims of the project is to identify the groups that tend not to participate, so we know how to better engage with those groups.”
During the retrospective study, researchers will look at the medical records of GSARP participants once they leave the post-acute setting. Those records will tell researchers how many hours of rehab the individuals received, and how well they functioned at the end of rehab, among other measures.
“We’ll be looking at whether their ability to carry out activities of daily living improved from admission to discharge,” says Cimarolli. “And we’ll be asking whether participation in the program was a significant predictor of that improvement. Are GSARP participants more likely to go home after rehab instead of either going to long-term care or back to acute care? We’re wondering if being part of the program could be a psychological motivator that helps people get better physically by improving the psychological aspects associated with addiction.”
OFFERING GUIDANCE TO NURSING HOMES
In addition to sharing study findings, researchers also plan to develop a manual that would help other nursing homes establish similar substance abuse recovery programs in their own post-acute settings.
“This is definitely a service that other nursing homes can offer,” says Cimarolli. “If a nursing home can hire someone who is trained as a substance abuse counselor, it is a fairly easy program to implement.”