Chapter 1: Introduction

Improving our Response to Older Adults with Substance Use, Mental Health and Gambling Problems: A Guide for Supervisors, Managers and Clinical Staff

Knowing how to help or how to best direct your staff to help older people with substance use, mental health or gambling problems is often difficult. Some service providers feel it is “too late” for older people to change or that working with people with these types of problems is not their responsibility. Others want to help, but feel that the resources they have at hand are inadequate, that they lack specific expertise or that they cannot begin to offer what is needed.

Because service providers are often unsure of whether or how they can help, some wait until a crisis occurs, by which point problems may have become even more complex and difficult to address. If the older adult in crisis doesn’t already have positive relationships with service providers, he or she may turn down offers of help. Frustrated service providers may interpret this refusal in negative ways, labelling the older adult as “difficult,” “non-compliant” or even “manipulative” and may dismiss the situation as hopeless.

Substance use, mental health and gambling problems in older adults often go unrecognized or are mistaken for signs associated with aging or other problems. As a result, problems that may be reversible or treatable are not considered. When problems are identified, the stigma associated with the condition often prevents older people from talking about it and from seeking help. However, research has shown that older persons do as well or better than their younger counterparts when they are treated for depression or substance use problems (Canadian Coalition for Seniors’ Mental Health, 2006b; Gurnack et al., 2002). Growing clinical experience and research indicates that many of the mental health issues of late life can be ameliorated and “functional decline” (a decline in older people’s physical and cognitive abilities) can be slowed down, if symptoms are promptly assessed and treated. Like people of any age, older people deserve appropriate care and treatment.

Due to an increase in life expectancy as well as the aging of the baby boomer generation (those born between 1946 and 1966), older adults are the fastest growing segment of the Canadian population. In 2000, about 13 per cent of the Canadian population was aged 65 and older; this percentage is expected to grow to 19 per cent by 2021, and to 25 per cent by 2041 (Health Canada, 2001). As the number of older adults increases, so too will the number of older adults with substance use, mental health and gambling problems.

You can prepare for the challenges this increase will present by learning ways to address these problems more effectively. You do not need to become an addiction or mental health counsellor. The role you have already may offer a unique and important opportunity to intervene and have a positive impact. The information and strategies provided in this guide will give you the knowledge and tools needed to identify issues early on, to understand what help is available and is appropriate for the older client, to prevent problems, avoid crises and to continue to support the person over time. Additional resources are given to continue to build knowledge, expertise and community capacity to respond to problems.