Post-its from Practice:
Don't forgot people get older (Jun 2010)
One of the other partners at the surgery asked me to see one of her patients. Angie was 54 years old and had been happily stable on 80mg of methadone mixture. She had always worked and had brought up her two children who had long left home, but she frequently saw and enjoyed caring for her two grandchildren. She had tried several times to become drug-free, but always felt unwell and odd so had decided to continue maintenance indefinitely.
She usually saw her GP every month for a review of her dependence, her blood pressure (which was raised) and her well-being. For the last 4-5 months Angie had been coming in more frequently complaining of tiredness, lack of sleep, night sweats and irritability. Angie was hepatitis C and HIV negative. After doing a full screen of blood tests which were all normal, Angie's GP wondered if she was becoming tolerant, and increased her methadone. The increase failed to help, so my colleague wondered if Angie was becoming depressed. After a full psychological assessment Angie agreed to try antidepressants. However these seemed to make the situation worse. As such, having run out of ideas, my colleague asked me to see Angie.
I reviewed Angie's history and then it occurred to me - what do 54 year old women frequently present with? The menopause! Angie had used an IUS so had not had a period for years. She therefore presumed she had finished the menopause, but upon further questioning, it became obvious her night sweats were clearly flushes, and her irritability was definitely hormonal.
With the increasing age of some people on long-term maintenance we have to remember that not only are they at risk of all of the usual conditions associated with aging, but they are also at increased risk of other conditions. National data shows rising number of older problem drug users service users in contact with drug treatment services.
Some physical health problems can result from prolonged smoking, alcohol and/or drug use as well as developing any of the diseases common in older patients, such as hypertension, diabetes, and chronic airways disease. Not forgetting liver damage and mental health problems.
Angie and I discussed the menopause and the possible options. She decided that now that she knew what was happening she didn't want to take any more drugs such as hormone replacement therapy we had great fun learning "imaging cold" to manage her flushes!
We need to remember to think about the whole person, who may use drugs, but is always so much more and who may have high levels of both physical and mental morbidity. Sometimes they are in poor health and may have low expectations of healthcare after years of being neglected and treated poorly. They will almost certainly have lost friends and may be isolated.
Meeting all the needs of older people who use drugs is a challenge that we must address. General practice is the perfect place from which to take it on!