51 2.5.9 Mental Health and Substance Use

Psychotic Disorders

2-3% of individuals in LTC have schizophrenia, however this data does not include all psychotic illness and may be under represented

• Includes:
  • Schizophrenia, Schizoaffective
  • Delusional Disorder
  • Late onset psychosis
• Overall prevalence of older adults affected by such disorders is low, 1-2% (new onset).
• Most individuals are diagnosed in early adulthood and have had chronic mental illness.
• Note: Chronic mental illness leads to chronic deterioration of brain tissue, increasing risk for cognitive decline.
• Clinical Considerations:
  • Geriatric dosing is often half of the adult dose – is the patient geriatric dosed?
  • Does the patient need lab monitoring (kidney, liver, CBC, drug levels) as they are geriatric with increased risk of renal/hepatic impairment and adverse effects?
  • QT Interval – is it in normal range?^[1][2][3]

Substance Use

Substance use is noted to increase the likelihood of admission to LTC. Individuals with alcohol use disorders have higher rates of LTC placement.

Substance Use in the Older Adult includes:

• Alcohol
• Benzodiazepines
• Cannabis Use
• Opioid Use^{[4][5][6][7][8][9]}