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The term “Harm Reduction” refers to strategies to help a person avoid harms associated with his or her behaviors. Many of the strategies were developed around alcohol and drug abuse behaviors.  These strategies have been found to work well with older adults who, due to cognitive impairment, lack insight into their behaviors. The goal is to work towards improving problematic behaviors while recognizing they often can not be eliminated. It is a non-confrontational and non-judgmental approach.

Why Use Harm Reduction?

Not every older person can stop or wants to stop risky behaviors.  The person may not be in a physical or psychological position to understand or consider their behavior is causing a problem and that change is possible.  Harm Reduction accepts these realities.

In fact Harm Reduction requires all supporting parties to accept that some level of harm will still continue because the behaviors cannot be eliminated, only mitigated.

Harm Reduction offers hope to the older adult, their family and those working with the person. It also provides practical and immediate actions that people can use to help improve the older adult’s life rather than waiting for “something to change,” or for the individual to improve at some unidentifiable future point. It often helps to stabilize or prevent situations from deteriorating further.

Harm Reduction is useful in situations where family, friends, neighbors, Adult Protective Services and others are concerned about the older adults danger to self but does not meet the criteria for a mental health intervention (or such an intervention has failed), where Conservatorship of Person is problematic at best and other situations where efforts to “impose” changes upon the older adult have failed.

Where to Begin

Harm reduction focuses on immediate harms in the person’s life and works for realistic goals. It begins with whatever problem that is important to address (for example, more secure in-home situation, improved health). It gives service providers a way to begin establishing and maintaining a relationship with an older adult who has a behavioral problem. It gives them strategies on how to offer assistance, even where the older adult feels “I am fine, just go away.” Harm Reduction is helpful whether the problem has been a long-standing problem, or is a more recent one for the older adult.

Self Neglect

We have found the utilization of Harm Reduction to be very effective with instances of self-neglect. Older adults who self-neglect are at risk for isolation, mental and physical health decline, nutrition and hydration decline, lack of medication adherence, financial loss, household deterioration and overall decline in quality of life.

Such individuals typically lack the insight to understand the risk of the their behaviors and they do not see the need for outside intervention.

Harm Reduction recognizes that the person will not willing participate in the elimination of all the risk, therefore the goal is to find areas where harm of self-isolation can be reduced.

Using Harm Reduction principles, we develop a Care Plan that addresses the critical areas that can be mitigated to reduce the harm. For example, critical areas are often medications and home safety.

To improve medication adherence (compliance), a review of the medications by the primary care physician often reveals that several doctors are prescribing and a simplified regime is not only possible but also medically beneficial.  In addition, applying the Harm Reduction model reduces the medications to the bare essentials while acknowledging a trade off between the opportunity for some compliance and none at all.

The single factor that makes Harm Reduction a successful approach to older adults is that it allows for a non-confrontational and non-judgmental approach (allowing the retention of a sense of control) while mitigating the harm that otherwise would continue unchecked.

References

• Marlatt. G. (1998) Harm Reduction: Pragmatic Strategies for Managing High-Risk behaviors. New York, NY: Guilford Press.

• Single. E. (January 31, 2000). The Effectiveness of Harm Reduction and its Role in a New Framework for Drug Policy in British Columbia. Presentation to the National Federal/Provincial/Territorial Meeting on Injection Drug Use, Vancouver.

• Eckfield. M. (Fall 2010) Evaluating and Selecting Interventions for Older Adults with Hording and Cluttering Behaviors.  Journal of Geriatric Case Management: Volume 20, Issue 2