Psychoactive substance use among residents of long-term care facilities for the elderly: a review of the literature on innovative practices

Residential and long-term care facilities (LTCFs) for the elderly are ill-equipped to deal with the increasing use of psychoactive substances (PAS) among their residents. There are currently no clear guidelines regarding practices or the organization of services to be adopted in this regard. The lack of adapted management has repercussions in terms of health and loss of autonomy for the elderly, but also for those around them, stakeholders, and resources. There is a need to support administrators and stakeholders who face these situations. The purpose of this study is to document innovative and recommended intervention practices for people who use PAS in LTCFs. We conducted a scoping review of the international scientific literature. From the 9,750 documents identified (seven countries represented, 2001-2021) in the databases (MEDLINE, EmBASE, PsychINFO, CINAHL, SocIndex, Ageline, Érudit), we selected 20 articles to be thematically analyzed. Three main themes emerged: (1) the philosophies underlying intervention practices related to PAS use, including findings related to how the elderly who uses PAS and the intervention (e.g., harm reduction, holistic approach) are considered; (2) the content of intervention practices, with a broad basket of services to address the diverse realities of individuals (e.g., aging, health comorbidities, social precariousness); (3) the organizational contexts and practical considerations to be taken into account: composition and training of staff, support modalities, facilities internal regulations, etc. This study suggests that offering a better support for the PAS use by elderly people in LTCFs would require an approach that emphasizes self-determination and respect for individuals, highly personalized and flexible support, and a fair and transparent internal regulatory framework. Finally, considering the aging of the population worldwide, it is crucial to provide clear local guidelines and have adequate resources to better meet the needs of LTCFs residents who use PAS.