A Substance Misuse Intervention Program in Postacute Care: Who Declines Participation?

Area of Science:

• Gerontology
• Public Health
• Addiction Medicine

Background:

• Alcohol and substance misuse are frequently underdiagnosed in older adults.
• Brief interventions show promise for addressing at-risk substance use in this population.
• Skilled Nursing Facilities (SNFs) are potential settings for delivering these interventions, but patient engagement factors are unclear.

Purpose of the Study:

• To identify patient characteristics associated with participation in a brief alcohol and substance misuse intervention within SNFs.
• To examine predisposing, enabling, and need-related factors influencing intervention uptake in postacute care.

Main Methods:

• A cross-sectional study analyzed medical records of 271 postacute care patients in a SNF with a history of substance misuse.
• Data on patient characteristics were collected upon admission.
• Participation was defined by enrollment (177 patients) versus refusal (94 patients) of a substance misuse intervention.

Main Results:

• Older age and belonging to an ethnic minority group were linked to a decreased likelihood of participating in the intervention.
• Widowhood was associated with an increased likelihood of participation.
• These findings highlight demographic disparities in intervention engagement.

Conclusions:

• Clinicians in SNFs must recognize that certain patient groups may be more prone to refusing substance misuse interventions.
• Targeted strategies are needed to enhance engagement among older adults at risk of refusal.
• Addressing underidentified substance misuse in older adults requires tailored approaches within postacute care settings.