Patricia W. Slattum

Background and Objectives: Problematic substance use among older adults is rising. Although rates of substance use disorder (SUD) are higher among younger populations, the percentage of older adults with SUD had the highest increase between 2020 and 2021 of any age demographic. Disparities experienced by racial minorities contribute to treatment gaps and lack of access to SUD resources. This study explores the perspectives of low-income, urban-dwelling, primarily racial minority older adults on SUD treatment and recovery. Research Design and Methods: Adults aged 50 years and older residing in urban low-income apartment buildings in Richmond, VA who self-identified as having a history of substance use were recruited to participate in semistructured interviews about their beliefs on substance use and aging, perceptions of treatment options and barriers to SUD-related recovery supports, and views around peer support. Interviews were recorded and transcribed. Inductive qualitative thematic analysis of the interviews was conducted using the framework method of analysis. Results: Interviews were conducted with 16 individuals. The mean age was 65.6 years, 56% identified as male, 25% did not complete high school, 50% reported an annual income under $10,000, and 81.3% were Black. Nine themes were identified from the qualitative analysis: Causes of SUD, stigma and misconceptions about SUD, SUD treatments, SUD self-help, SUD and aging, barriers to treatment, defining recovery, lack of knowledge of current terminology, and the role of technology. They perceive that the reasons underlying SUD differ with age, with younger people more influenced by social pressure/environment and older people by social isolation or loneliness. Discussion and Implications: This study highlights the perspectives of low-income, racial minority older adults providing insights into barriers to SUD treatment and recovery, opportunities for community education, and adaptation of current treatment strategies to meet the needs of this population.

Increasing demand for quality holistic care is one of the factors driving interprofessional education (IPE) efforts globally. Opportunities for students that are reflective of current healthcare ne...

Primary care clinicians have an important role in the management of dementia and have expressed interest in continuing education. The authors describe a model they used for providing dementia education in primary care, Project ECHO (Extension for Community Healthcare Outcomes), and an overview of its major features. A partnership including academic institutions and a national healthcare association is then outlined, including the unique features of the ECHO model developed through this partnership. A mixed-methods methodology was used for programmatic evaluation. This use of mixed methods adds vital new knowledge and learner perspectives that are key to planning subsequent ECHO courses related to dementia and primary care. The discussion includes an exploration of the significance of these findings for understanding the motivations of primary care providers for participation in the educational program, as well as the limitations of the current study. A final section explores the next steps in the continued development of the model and its implications for geriatrics education in dementia care, especially the supportive role that ECHO courses can play in meeting the challenges of dementia care.

A successful interprofessional faculty development program was transformed into a more clinically focused professional development opportunity for both faculty and clinicians. Discipline-specific geriatric competencies and the Interprofessional Education Collaborative (IPEC) competencies were aligned to the 4Ms framework. The goal of the resulting program, Creating Interprofessional Readiness for Complex and Aging Adults (CIRCAA), was to advance an age-friendly practice using evidence-based strategies to support wellness and improve health outcomes while also addressing the social determinants of health (SDOH). An interprofessional team employed a multidimensional approach to create age-friendly, person-centered practitioners. In this mixed methods study, questionnaires were disseminated and focus groups were conducted with two cohorts of CIRCAA scholars to determine their ability to incorporate learned evidence-based strategies into their own practice environments. Themes and patterns were identified among transcribed interview recordings. Multiple coders were used to identify themes and patterns and inter-coder reliability was assessed. The findings indicate that participants successfully incorporated age-friendly principles and best practices into their own work environments and escaped the silos of their disciplines through the implementation of their capstone projects. Quantitative data supported qualitative themes and revealed gains in knowledge of critical components of age-friendly healthcare and perceptions of interprofessional collaborative care. These results are discussed within a new conceptual framework for studying the multidimensional complexity of what it means to be age-friendly. Our findings suggest that programs such as CIRCAA have the potential to improve older adults’ health by addressing SDOH, advancing age-friendly and patient-centered care, and promoting an interprofessional model of evidence-based practice.

Changes that accompany older age can alter the pharmacokinetics (PK), pharmacodynamics (PD), and likelihood of adverse effects (AEs) of a drug. However, older adults, especially the oldest or those with multiple chronic health conditions, polypharmacy, or frailty, are often under‐represented in clinical trials of new drugs. Deficits in the current conduct of clinical evaluation of drugs for older adults and potential steps to fill those knowledge gaps are presented in this communication. The most important step is to increase clinical trial enrollment of older adults who are representative of the target treatment population. Unnecessary eligibility criteria should be eliminated. Physical and financial barriers to participation should be removed. Incentives could be created for inclusion of older adults. Enrollment goals should be established based on intended treatment indications, prevalence of the condition, and feasibility. Relevant clinical pharmacology data need to be obtained early enough to guide dosing and reduce risk for participation of older adults. Relevant PK and PD data as well as patient‐centered outcomes should be measured during trials. Trial data should be analyzed for differences in PK, PD, effectiveness, and safety arising from differences in age or from the presence of conditions common in older adults. Postmarket evaluations with real‐world evidence and drug labeling updates throughout the product lifecycle reflecting new knowledge are also needed. A comprehensive plan is needed to ensure adequate evaluation of the safety and effectiveness of drugs in older adults.

This study aims to determine whether current tobacco and/or alcohol use is associated with setting preferences for seeking support for substance use (SU) and mental health (MH) services to African ...