Transcript The AERC Alcohol Academy

Specialist
approaches in
alcohol
treatment for the
elderly
James Morris
Academy Programme Lead
10th February 2010
Aims
• Do we need specialist approaches?
• Explore some of the existing models of
specialist alcohol treatment for older people
• Identify some of the key issues and challenges
Do we need specialist treatment
approaches for older people?
• Alcohol use/consumption affects older people
differently!
• Different range of needs and sensitivities
• Accessibility!
• Raising recognition of the issue & challenging
perceptions
• Integrated older people services are best?
• Does not need to be specific services
Stepped Care approach
‘Signs for improvement: commissioning
interventions to reduce
alcohol-related harm’ DoH 2009
Remember the IAS fact sheet
• Early-Onset drinkers or ‘Survivors’ are those
with a continuing problem with alcohol which
developed in earlier life.
• It is thought that 2/3rds of elderly problem
drinkers have had an early onset of alcohol
misuse.
• These drinkers are likely to need more
intensive support than brief interventions
What does MoCAM say?
• B4.8 "Community settings are preferred for the
treatment of the majority of alcohol misusers, both
because individuals need to learn how to change their
drinking in their normal social environment and
because it is cost-effective.
Those individuals who are unable to leave the home or
who would have difficulties attending a specialist
agency – for example older people, disabled people and
parents with childcare responsibilities – may need
specialist alcohol treatment in their own homes or other
community settings."
Model 1:
Dual Diagnosis amongst older people
in Southwark
Overview
• Mental Health of Older Adults team (MHOA)
• Open Access service
• Dual Diagnosis provision established within
existing resources
• Lead by team consultant, Dr Tony Rao
North Southwark profile
• Inner London
borough
• ~13,000 over 65s
• Large ex-dock
worker
population
• Significant older
Irish population
Model 1:
Dual Diagnosis amongst older people
in Southwark
Need?
• High alcohol-related hospital admissions from
the locality
• High overall referral numbers to MHOA
• Between 10-20% of referrals had dual
diagnosis/alcohol misuse
• Onward referrals were often not accepted –
people were caught between services and
conditions often worsened
Model 1:
Dual Diagnosis amongst older people
in Southwark
Need?
• In 2003 all 14 people at one point had dual
diagnosis for alcohol misuse:
• 43% showed ICD alcohol dependence
syndrome
• 21% showed ‘harmful use of alcohol’ 21%
showed ‘harmful use of alcohol’
• 71% suffered physical problems
• 57% admitted to MHOA ward or presented to
A&E
Model 1:
Dual Diagnosis amongst older people
in Southwark
Response:
• Team consultant (MSc in addictions) to carecoordinate all dual diagnosis cases
• Delivery of screening for alcohol followed by
brief interventions and psychosocial
interventions as appropriate
• Key partnerships with Older Adults services
including housing and Irish Pensioners Project
• Delivery of level 1 (generic) Dual Diagnosis
training across the trust, as part of DD strategy
Model 1:
Dual Diagnosis amongst older people
in Southwark
Outcomes:
• Between 2005 to 2009, there was a 90%
reduction in alcohol-related hospital
admissions for Older People from north
Southwark
• However alcohol harm still appears to be
rising and there has been an 80% increase in
Dual Diagnosis instances on the caseload
Model 1:
Dual Diagnosis amongst older people
in Southwark
Tony, what are the key components?
• Improved training in screening and referral
• increased awareness in primary care and
addictions services
• improved relationships with voluntary
agencies
Model 2:
Older People’s outreach service in
Hammersmith & Fulham
Overview
• Foundation 66 specialist alcohol service
employ 2 specialist older people & alcohol
posts
• Placed within Adult Social Services Drug
and Alcohol Team
• Outreach model of weekly home visits for
identified clients with alcohol needs
Model 2:
Older People’s outreach service in
Hammersmith & Fulham
Delivery
• Senior worker and assistant practitioner
carry out weekly home visits based on full
assessment and support plans
• Includes triage and referral and joint
working with a wide range of services
• Specific training delivered to housing
managers, care managers, healthcare workers
and volunteers
Model 2:
Older People’s outreach service in
Hammersmith & Fulham
Outcomes
• The service is proving very popular with
clients and partners
• Anecdotal evidence shows that screening
and brief interventions are proving effective
Model 3:
Older People’s day service in County
Durham
Overview
• ‘The Whitehouse project’
• Day service for older adults with alcohol needs
• Referral for alcohol-related hospital
admissions
• Free transport collects and returns people to
their homes
Model 3:
Older People’s day service in County
Durham
Service user needs
• Liver issues
• Poor mental health
– Low moods
– History of Self harm
• Poor nutrition
• Poor mobility – frail
• Cognition problems due to
premature ageing
• Lonely & isolation
• Family respite
Provider/commissioner
issues & needs
• Hospital Admissions target
• Identified gap/ Community
Alcohol Service pathway
• Better understanding
• Consultant issues
–
–
–
–
Bed blocking
Younger patients
Family support
Constant revolving door
client group
– Costs to the PCT
Model 3:
Older People’s day service in County
Durham
Delivery
• Existing service of Durham
Alliance Community Care
(DACC) providing day
service for older adults
• Specific referral pathway
from hospital Alcohol
Liaison Nurse/Community
Alcohol Service
Model 3:
Older People’s day service in County
Durham
Outcomes
• Undergoing evaluation but:
– Staff
‘When you come to the White House project there
is no pressure. As a group we have gelled and we
can get strength from each other and from the
staff’
– Peer/Mutual support
‘There is something powerful about seeing others
do well and get healthy – it makes you think if
they can do it then why not me?’
– Families
‘My family is over the moon’
‘I think that my wife feels she gets a break’
‘Counselling people with dementia and
alcohol problems’ Fox 2008
• Particular risk of alcohol harm and problems
amongst dementia sufferers
• Social isolation a significant factor
• Responses should include
– Early identification
– Individualised care and support strategy
– Collaborative working essential
– Innovative approaches recognising cognitive
impairments
Further info & contacts
www.alcoholacademy.net
www.alcoholpolicy.net
James Morris, AERC Alcohol Academy
[email protected]
0207 450 2930