The paper dwells upon the problem of substance abuse, alcohol addiction and HIV in older adults. Having focused on the history of the problem development, specification of the age group, chronic diseases related to the issue and methods to prevent them, the paper discusses the main threats faced by older people in relation to chronic diseases and the diseases caused by substance abuse, alcohol addiction and HIV infection. Along with the description of the problem, the prevention programs and policies are considered. The paper concludes with the modern strategies aimed at coping with substance abuse, alcohol addiction and HIV infection; moreover, the recommendations on how nurses and social workers may influence the successful treatment strategies are provided.
History of the Problem Development
The problem of substance abuse, alcohol addiction and HIV in older adults has never been a serious issue till nowadays. The number of people who abuse different substances, who are alcohol addicted, and HIV infected increases every day. According to the statistics, the number of newly infected people reduces from year to year. Thus, in 2005 there were 5.473 newly infected people in the USA and in 2008 the number reduced by 4.4%. But the number of infected people again increased in 2009. Still, it does not reject the problem of elderly people living with HIV. The issue is complicated with numerous additional diseases elderly people experience which prevents them from leading a normal life (Stanhope& Lancaster, 2013). The problem of drugs addiction increases, which affects the HIV infection. Abusing intravenous drugs people usually use the same needle that causes HIV/AIDS transmission. Overall, the number of people aged 50-59 who consume different types of drugs increased from 2.7% in 2002 till 6.2% in 2009 (Volkow, 2011). Alcohol addicts of older age create a separate risk group. The average annual increase of alcohol abuse among the elderly was 2.8 from 2002 till 2006. The number of people who abuse alcohol only dramatically decreased from 1992 till 2009. According to another research, “older people needing substance abuse treatment will increase by more than 250% and reach 4.4 million by 2020” (Arndt & Schultz, 2011, p. 710). However, the number of elderly people addicted to both alcohol and drugs has increased. The treatment of older people suffering from substance abuse, alcohol addiction and HIV infection should be of the highest priority with the development of the appropriate policies and quality treatment strategies as the number of elderly people in the risk groups mentioned above is going to increase in the nearest years.
Specification of the Group
People aged 65 and older are one of the fastest growing segments of US society. It represents about 13% of modern US population and this number increases every day. Statistically, elderly people will constitute 21% of the US population by 2030. Considering the problem from a medical side, of all medications in the USA are prescribed to elderly people now (Stanhope& Lancaster, 2013). An increase in the number of this social segment will lead to the increased necessity of more drugs and nursing care. Apart from the existing problem of drugs, alcohol, or HIV, risk group also suffers from usual elderly diseases; chronic diseases are also a problem. Still, the traditional methods of treatment may be problematic.
Chronic Diseases Related to the Issue
The consumption of drugs, alcohol abuse and HIV infection provoke the development of very serious chronic diseases in elderly patients. Suffering from HIV, people may develop numerous chronic diseases. Having a purpose to reduce the number of deaths due to AIDS, HIV has become a chronic disease itself. Numerous medications used while treating HIV have led to liver-related morbidity and high mortality. This increase in non-alcoholic liver diseases is a very serious problem as the number of alcoholic liver diagnoses does not reduce. The problem is complicated with the inability to use traditional methods of liver treatment due to HIV diagnosis (Joshi, O'Grady, Dieterich, Gazzard, & Agarwal, 2011). Older people with HIV, who abuse drugs and are alcohol addicted for several years have very serious health issues. Having worse health as compared to younger people in general, older people are more subjected to being infected or catching any disease. Moreover, the processes in the organism of older people are slowed that creates a number of problems.
According to Reif, Larson, Cheng, Allensworth-Davies, Samet, and Saitz (2011), “hypertension, diabetes, asthma, chronic liver disease, chronic obstructive pulmonary disease (COPD), pain, and stroke” (p. 3) are serious chronic diseases, which have the tendency to be doubled in people who abuse drugs. Older age may also create additional problems to any of the diseases mentioned above. HIV, alcohol addiction and drugs consumption destroy human organism. Older people have a lot of diseases due their age and if they are drugs or alcohol addicts, they are more subjected to viruses and diseases. HIV is also a problem which negatively influences human body destroying it from inside. So, asthma in an older person, who doesn’t suffer from any addiction, may be just a reason to take pills and be attentive. For an older person with any kind of addiction asthma may create a lot of problems, like from difficulty to breathe to very serious, even life-threatening conditions (Reif, Larson, Cheng, Allensworth-Davies, Samet, & Saitz, 2011). Suffering from alcohol or drug addiction or HIV older people suffer from other supplementary chronic diseases.
Chronic depression is one serious issue to be taken into consideration. Drinking may lead to an increased risk of depression. Age is one more provoking factor, which may cause a number of problems (John, Snow, & Tyas, 2010). Depressions in older people are very serious problems as treatment presupposes implementation of not only medication but also constant nursing and professional assistance. Psychiatrists and psychologists should conduct a constant monitoring of a patient’s condition. Depression in older age can provoke numerous diseases which influence the development of human body. Older people are unable to carry a burden as compared to younger people. Depression may cause serious heart issues, mental disorders and other additional problems.
Cardiovascular disease is one of the main problems faced by older people in the USA. Cardiovascular disease in HIV infected people and drug and alcohol addicts usually leads to very serious complications, like cardiomyopathy and pericarditis. However, due to the development of science and antiretroviral therapy the problem was prevented. Nowadays, “premature coronary atherosclerosis” (Sudano, Spieker, Noll, Corti, Weber, L?scher, 2009, p. 1150) becomes a very serious issue. This complication of cardiovascular disease in HIV infected people can lead to “serious metabolic disturbances resembling those in the metabolic syndrome” (Sudano, Spieker, Noll, Corti, Weber, L?scher, 2009, p. 1150) in case of applying antiretroviral drugs. Alcohol and drug addicts also suffer from a lot of heart problems (Freiberg, & Kraemer, 2010).
Methods to Prevent Them
It is worthwhile to note that the treatment of drug and alcohol abuse puts a number of limitations on the treatment of chronic diseases (Reif, Larson, Cheng, Allensworth-Davies, Samet, & Saitz, 2011). Suffering from any chronic disease people should understand that they have drug dependence. Substance addicts and HIV infected people do not have this understanding. Also, the negative effects have the substances and HIV status. Thus, for example, while treating cardiovascular diseases alcohol consumption leads to the development of the problem, not its cure. At the same time, some treatment methods aimed at curing one disease positively affect another one. Treatment of depression may positively influence alcohol consumption. It has been suggested that “treatment of depression was associated with a modest benefit for depressive symptoms and alcohol use” (John, Snow, & Tyas, 2010, p. 63). So, the consumption of antidepressants may positively influence both diseases.
A lot of barriers appear on the way to recovery in older people who suffer from drug and alcohol abuse being HIV infected. Mellins et al. (2011) insist on importance of undergoing treatment, but older people usually consider their health as something not important. As a result, they appear to be busy with other business, to forget, or to ignore intentionally the medication as this is not an important part of their life. Treatment of elderly people with different disorders is a very complicated issue that requires additional consideration due to the predicted increase in a number of elderly people suffering from HIV infection, drug and alcohol abuse in several years. Modern treatment methods are very effective. Still, alcohol and drug abuse as well as HIV infection require the help of professional psychologists. Older people need such treatment more frequently. Psychologists may influence human behavior and as a result they may correct it having influenced alcohol and drug addiction (Walters & Rotgers, 2011).
Specific Disease Threats in Older Adults
Older people are subjected to numerous diseases. Diabetes, cardiovascular diseases, asthma, infectious diseases, mental disorders and many other diseases occur more often in elderly people due to their age as compared to other age groups. Older people have many chronic diseases and the subsequent disease as influenza or cough may become a serious challenge for them. Older people have numerous diseases and a policy should be developed to assure provision of quality medical services to elderly people.
Medical problems in older adults. Older people have to deal with numerous medical problems. Heart diseases remain one of the main problems of the aged people in age. Recent research shows that older people with good health condition and no heart problems may develop fatigue that is an early predictor for ischemic heart disease. According to Ekmann, Petersen, Manty, Christensen, and Avlund (2013) fatigue is not just a simple daily problem. Older people should understand that even a long walk and overwork in their age may be a cause of serious health issues especially those related to heart. If feeling fatigue older people must check their heart even if they didn’t have any heart problems before. Another serious disease which is common in older people is diabetes. According to statistics, over 25% of Americans aged 65 and above have diabetes. This problem would not be a serious issue if it did cause “both acute and chronic microvascular and cardiovascular complications of the disease” (Kirkman et al., 2012, p. 2650). Older people are subjected to numerous diseases and the main problem is that most of them provoke other problems, which require serious treatment. The type 2 diabetes epidemic among older people has been caused by increased cases of obesity and overweight. Younger people mind their weight but becoming older they forget about proper nutrition, do not move much and as a result suffer from different health problems. Cardiovascular diseases and diabetes are closely related in older people.
Asthma is another problem, which is common in older people. Suffering from numerous pulmonary issues asthma may be referred to as a complication or a result of underdiagnosis and undertreatment. The prognosis is very disappointing; according to different statistics the number of older people with asthma will increase in 20 years. There were many children who suffered from asthma in the 1980s. These children are growing older and some years later they will be adults. Thus, asthma is a very serious concern for elderly people. According to Gibson, McDonald, and Marks (2010), of deaths because of asthma occur in people aged 65 years or older.
Mental disorders also occur in older adults. Even though people of all ages may develop numerous mental disorders, the number of older people with this problem increases. Schizophrenia in older adults is complicated by a limited number of research projects. It means that there are no particular strategies to deal with older people who suffer from the disease. Older people represent a particular age group which needs special attention and control. Schizophrenia in older adults may have a lot of different reasons. This problem is complicated by the inability of a person to stay alone. A constant nursing assistance is required. Unhealthy lifestyle, adherence to treatment, and limited financial resources are the barriers to successful treatment. As a result, the number of deaths caused by schizophrenia in older age increases (Sorrell & Collier, 2011).
Prevention programs which will educate the elderly on risk behavior. According to Kirkman et al. (2012), elderly people require more attention in relation to their diseases. Correction of their behavior, medication and other treatment measures are necessary. Resent researches helped to investigate the possible interventions necessary to treat diabetes. Behavior correction should go along with glycemic control, lipid control, blood pressure control, and aspirin consumption control (Kirkman et al. 2012). Changes in behavior are required for people with heart diseases. Suffering from any kind of cardiovascular disease means that one should change the mode of life he/she used to. This is very difficult and in order to do it correctly one should have a serious motivation and supervision. Any treatment in older age along with medication requires changes in behavior and the mode of life. Nurses are interested in impacting their patients, and they are to follow special policies developed for particular cases.
Not many officially confirmed programs exist aimed at reducing risk behavior among older adults. However, a lot of researches have been conducted with testing many programs aimed at preventing risk behavior among adults. Older people are more subjected to many injuries caused by the failure to lead safe lifestyle. According to Koestner, Walters, Mattice, Manion, and Seguin (2009), “senior people with quality-of-life limitations may be aware of their increased risk and more willing to make changes to enhance safety” (p. 87). Thus, prevention programs are very important in the current circumstances. Having developed a prevention program aimed at reducing disease risk in older people, the researchers focused on nursing actions aimed at assisting senior people. The first step in this prevention program is screening which involves diagnosing of all possible diseases and understanding of human behavior. The next step is assessment of the impact of the lifestyle on diseases a person has developed. The analysis of the found information and creation of the preliminary action plan take place. An action plan should be agreed on with a patient or his/her relative. Then the planned actions should be executed. Evaluation of the conducted actions should occur from time to time to be able to monitor the results, achievements and the possibility to create a follow-up aimed at correcting the plan if necessary (Daniels et al., 2011).
Older people need programs aimed at risk prevention and behavior correction. Obviously, intervention into senior people’s life is necessary in order to make necessary corrections and to direct older people in their actions. Each person should experience an individual approach. Behavioral changes are difficult to implement even in case self-efficacy is high. Nurses should apply different models and methods aimed at changing older people`s behavior. “Reattribution training, relapse-prevention, planning coping responses, and methods to train skills and self-efficacy are the methods aimed at correcting behavior in older adults and assist them in developing healthy and safe lifestyle” (Bartholomew, Parcel, Kok, Gottlieb, & Fernandez, 2011).
Discussion of the Problem
According to the Center of Disease Control and Prevention, there are a number of policies and programs aimed at dealing with HIV infection and helping people who suffer from this disease. On the web site of the organization the following policies and reports are presented, namely Affordable Care Act, Expanded Testing Initiative, National HIV/AIDS Strategy, High-Impact Prevention, National Progress Report, DHAP Strategic Plan, Prevention Status Reports, and DHAP Annual Report (Policies and Programs, 2014).
Prevention and care for the elderly living with HIV/AIDS. Affordable Care Act pays attention to the necessity of the treatment to be affordable. Affordable Care Act was introduced by president Obama during his healthcare reform. This policy helps people with HIV get insurance and proper care. This act ensures better access to information, quality and comprehensive care, preventive and coordinated care. This Act assures that people with low income get help and assistance and equal treatment. This is particularly important as according to the statistical information, gay people, Latinos and African Americans are more subjected to being infected (Policies and Programs, 2014).
Expanded Testing Initiative is aimed at increasing the number of people aware of their status. Those people who unaware of their HIV status bring a lot of problems to the society than those who are aware of it. Thus, Expanded Testing Initiative is aimed at increasing the number of people who know about their status. Being aware of the HIV status a person will act appropriately in order to control personal actions and get necessary treatment. According to this policy, the government wants to reduce the number of newly infected people. The National HIV/AIDS Strategy has several main purposes, namely to improve health outcomes for those people who suffer from HIV infection, to reduce the number of newly HIV infected people, to increase human access to health care, to reduce disabilities and health issues related to HIV infection, and to assure that the state is aware of the scope of the problem and implements all possible means to prevent HIV epidemics (Policies and Programs, 2014).
The High-Impact Prevention Program aims to “advance the prevention of goals of NHAS and maximize the effectiveness of current HIV prevention methods, CDC pursues a High-Impact Prevention approach” (Policies and Programs, 2014). National Progress Report informs population about the achievements of the current policies and programs. The number of newly infected people and the results of successful treatment are also presented to show the real state of the problem and to encourage people to cope with HIV. The policy developers are sure that the information increase in media positively influence people and make them act in a protective way. Awareness may save people from being infected and increases their safety. DHAP Strategic Plan is the plan aimed at making the future free from HIV. The plan includes the steps which both the government and society should implement in order to reduce the number of newly HIV infected people to assure that the future will be without this dangerous virus. Prevention Status Reports and DHAP Annual Reports are aimed at providing the statistics and reports about the actions the Center of Disease Control and Prevention has conducted in order to create HIV free society.
The modes of transmission of HIV infections. Case et al. (2012) have presented the detailed information on the modes of transmission aimed at increasing the understanding of the problem among US society and assisting national planning programs aimed at creating HIV free society. To understand the main idea of the modes of transmission, one has to know the history of its development. Being developed in 2002, it was designed for understanding a risk group. The aim of designing the modes of transmission was to implement faster and better information strategies directed at prevention of the disease. The peculiarity of the mode of transmission is that it can be applied at any setting, regardless of a country or region involved. The main idea of the modes of transmission is to calculate the predicted number of newly HIV infected people in the society referring to the current distribution of infection among population and the assumptions of risk behavior.
Case et al. (2012) describe “the inputs to the model, which are based on a comprehensive review of available epidemiological and behavioral information”, as follows:
- the proportion of the adult male and female population that belongs to each of several risk groups;
- the prevalence of HIV infection and of a generic sexually transmitted infection (STI) within each risk group;
- the average number of sexual or injecting partners per year and the average number of exposures per partner, taking into account the average level of protective behavior, for individuals in each risk group;
- the probability of HIV transmission per exposure act in each risk group, taking into account the effect of STIs and the prevalence of male circumcision (Case et al., 2012).
The use of the mode of transmission model helps to predict the number of newly infected people in the region. This information is useful for many reasons. First, the state has information which, when analyzed, may answer the question whether HIV prevention programs work or not. In case HIV prevention programs appear to be ineffective, the state and related agencies have an opportunity to reconsider the program, to find faults and to assure the effective revision of the current policies (Case et al., 2012). HIV infection is a very serious issue in the world society. Many countries search for possible resolution of the problem and only the cooperation in strategies and actions worldwide may assist in dealing with this infection.
Resolution of the Problem
Alcoholism and drug abuse remain very important problems in the modern society. Availability of alcohol and easy access to drugs through dealers causes numerous problems. Alcohol and drug addicts cannot control their behavior and harming personal health they may also harm others` health. The government and related agencies are working on the development of the effective prevention strategies aimed at reducing the number of newly infected and addicted people. At the same time the strategies are developed aimed at helping those who have already been subjected to harmful influence of the issues mentioned above.
Modern programs aimed at treatment of alcoholism and drug abuse. There are a number of modern programs aimed at treatment of alcoholism and drug abuse; however, not all of them are effective. The problem of alcohol and drug abuse should be considered individually as different people may have various reasons for being subjected to such an abuse. Treating the symptoms is a not good way out as only having coped with the reasons of addiction people will be cured. The problem with elderly people is complicated by a number of supportive and chronic diseases this group of people usually develops. As it has been already mentioned, the number of modern programs aimed at dealing with alcoholism and drug abuse is substantial. Still, they all have similar basis. Weiss and Connery (2014) at McLean Hospital insist that an individual approach to each patient is crucial. Personalized and comprehensive treatment guarantees a successful outcome. One of the main purposes of the treatment at McLean Hospital is to help addicted patients to achieve and maintain abstinence. Patients should understand that they are the deserving members of the society; they should feel personal worthiness in the world. The first step in treating alcoholism and drug abuse is stress coping. Most people who suffer from the abuses mentioned above also suffer from depression. Stress disorder will prevent application of any strategies when dealing with the problem. Thus, coping with stress and depression should become the main focus of nursing care in the problems mentioned above (Weiss & Connery, 2014).
Prevention efforts. Prevention efforts should be based on the most common causes of the problem development. The agencies coping with alcohol and drug addictions should deliver a lot of information. If a lot of information is available about the harm of alcohol and drugs abuse, less people may be interested in trying it. The prevention efforts directed at reducing the number of alcohol and drug abusers should be applied not only in a form of informative leaflets but healthy lifestyles should be promoted. Films and ads should expose as minimum alcohol consumption as possible. Now, many people in movies smoke and this is considered as a norm. Many film stars are drug addicted in real life and this information is available worldwide. People see it and they are sure that drug consumption is not a bad thing if celebrities consume drugs. Copying favorite actors and singers, young people become addicted. This is a real problem; that’s why along with the information about the harm of drugs and alcohol such propaganda favors the use of dangerous substances. As a result, the prevention efforts are run in vain. Agencies should do all possible to protect people. The prevention policies and strategies remain ineffective since propaganda of drug and alcohol abuse remains on the screen.
Social work involvement. Social work remains a very valuable aspect aimed at coping with alcohol and drug abuse. Nurses are responsible for working with addicted people. However, apart from performing their direct medical responsibilities they are to provide additional psychological assistance. Drug and alcohol addicted people are those who are subjected to stress. Nurses can positively influence these people, but they need more information and training. Apart from nurses, alcohol and drug addicts need assistance provided by social workers. According to Galvani (2012), social workers do not have enough qualification and information on how to deal with alcoholics and drug addicts. Social workers need to receive additional trainings to have a positive effect on the group of people in danger. As it has been already mentioned above, drug and alcohol addicts are subjected to stress and depressions. Social workers may assist these people to cope with possible problems just talking to them. In regard to the elderly, it is obvious that some of them are very lonely people and that time which social workers may spend with them may prevent them from consuming drugs or alcohol. Attention is very important to elderly people with numerous addictions. Paying more attention to this risky group may reduce the number of consumed alcohol, which may cause complete recovery from addiction in the future. Drugs and alcohol abuse is not only a medical issue but also a social one. Modern society is very aggressive and creates the possibility for depression development. Some people search for help from depression in alcohol, while social workers may assist them in overcoming their problems (Galvani, 2012).
In conclusion, the number of HIV infected people, alcohol and drug addicts does not reduce annually in spite of the numerous policies and prevention programs. People have free access to alcohol and drugs, moreover, a lot of people engage in unprotected sex with strangers; all these factors lead to spread of different diseases. The problem of HIV infection, alcoholism and drug abuse should be given special attention in the health care sector. The number of older people is going to increase. Nowadays, many adults have serious addictions and becoming older they will develop numerous chronic diseases, which will cause many health problems. The treatment of older people suffering from substance abuse, alcohol addiction and HIV infection is taken seriously in the USA. Also, the appropriate policies and high quality treatment strategies are developed as the number of elderly people in the risk groups mentioned above is going to increase in the nearest future. Further researches should be directed at the reasons for alcohol and drug addictions; this may help the specialists to create the prevention programs and to assure that modern young generation does not repeat the experience of their parents and grandparents. Overall, the problem is very serious and requires special attention as the reasons for HIV infection, drug and alcohol abuse may be different. Thus, the ways of treatment should vary as well.