Psychology professor Tanja Hoff from the German Institute on Addiction and Prevention Research at the Catholic University of Applied Science North Rhine-Westphalia (German: Deutsches Institut für Sucht- und Präventionsforschung an der Katholischen Hochschule Nordrhein-Westfalen) is the director of the "Alters-CM3" project. REHACARE.com spoke with her about the goals of the project and the care of older persons suffering from drug addiction.
The three-year project "Alters-CM3" has been running now for almost one year. What were you able to achieve during the past twelve months?
Prof. Tanja Hoff: During the past ten months of the project, the required network structures of the project were being set up and intensified. One central work package was the development and conduction of a standardized survey of the target group on psychological, physical and social strains that has now been almost concluded with 108 test persons in the three regions of Koblenz, Frankfurt am Main and Cologne/Düsseldorf. Compared to previous studies with older drug users that were primarily of a qualitative nature, our investigation is extensively based on standardized test instruments, so that an adequate quantitative statement on the types and extent of strains can also be made for the first time.
In addition, an initial quantitative network analysis of the cooperation of participating services was developed and tested; the major work package of the next year of the project will be to refine it and use it to promote an outpatient care network for older drug users.
Also in development is a comprehensive continuing education model on target group-specific case management led by our project partner, the University of Koblenz under the direction of Professor Martin Schmid.
What are the care needs of older drug users?
Hoff: Today, people in Germany who are addicted to illegal drugs like heroin are getting considerably older than assumed in the past. One reason for this is substitution treatment and the overall well-developed medical and psychosocial care for drug addicts. However, this also goes along with a shift in the problem. Several studies suggest that older drug users are not only significantly afflicted in terms of their health and psychosocial makeup but are also affected much earlier than others by age-related problems such as mobility restrictions and increased care needs.
During the next few years, the number of older drugs users in need of care and age-related diseases will increase considerably. The necessary familiar surroundings to facilitate in-home care are lacking in most cases. What’s more, the somatic and psychiatric multimorbidity of the target group, frequent dropping out and subsequent resuming of treatments, exclusion experiences thanks to long-term drug use as well as the social isolation of many older drug users make adequate care difficult. Due to the lack of appropriate employment history, entitlement to health insurance, long-term care insurance, and pension insurance coverage is often missing so that the costs for this are largely going to be assumed by the communities.
How can outpatient and inpatient care actually cope with these needs?
Hoff: So far, outpatient care services, inpatient care facilities and other facilities caring for the elderly don’t have a lot of experience in providing medical and psychosocial care for older drug users who are usually looked after by drug and addiction counseling services financed by the communities that frequently lack age and care-specific skills.
This is why the organization of appropriate outpatient (and if required also inpatient) care structures through an increased integration and collaboration between drug and addiction counseling services, elderly care and health care both on an individual case basis as well as on the local care system level take center stage in the Alters-CM3 project. From our point of view, the case management model should primarily be used here but still needs to be refined based on age and needs.
In addition, there are recommended actions stemming from one of our other projects on inpatient care for handling risky alcohol and drug abuse among older residents as well as care interventions for older residents who previously used illegal drugs.
What challenges are you anticipating during the course of the project?
Hoff: One particular challenge is definitely going to be to maintain the target group in the case management model over an extended counseling process since the biographical and help-related experiences of older drug users are often shaped by people dropping out and resuming treatment numerous times. However, we already experienced in our conducted needs assessment survey that the interviewed older persons are very interested in studies and services that are adapted to them, which makes us optimistic about achieving random sampling.
Another challenge will be to achieve a joint cooperative treatment and monitoring of this target group, especially in terms of addiction counseling and elderly care. We know from other projects that very different professional and organizational ideas are partially clashing in this case.
What is the ultimate goal of "Alters-CM3"?
Hoff: To primarily improve the quality of life and the care services for older drug users. And to enhance evidence-based methods and concepts and make them available for practical use.
