Transcript Slide 1
Alcohol and Older People Radomir Lazarevich, Area Manager 29 November 2010 Introduction Size and nature of the problem Typology Age specific interventions Pilot projects summary of findings Design Results Recomendations An Invisible Epidemic • 17% of all men, 7% of all women exceed the ‘sensible limits’ of alcohol consumption (Household Survey,1994) • Of 86% elderly patients requiring treatment for the effects of ‘binge drinking’ 76% began drinking in mid/later life- Canada • 1991- 10.6 mil (16% raise from ’71.), projected 14 mil by 2031- pensionable age population in the UK • Substance abuse related cases cost about 26% more to treat (23% of total payments for hospital care Medicare) • Problematic drinking in nursing homes estim. at 49% • 6-11% of elderly hospital admissions exhibit symptoms of depend drinking, 20% in psych wards, 14% of elderly in A&E Unique vulnerabilities • • • • • • • • • Metabolism slows down with age Lower body mass Lower proportion of water in a body Decreased hepatic blood flow- liver will receive more damage Interaction with other medical conditions and interaction of alcohol with medication taken as a treatment of those conditions Inefficiency of liver enzymes- alcohol broken down inefficiently Psycho- social challenges of ageing and impact of alcohol (isolation, depression, memory deterioration, change of role, food preparation skills, opportunities, nutritional needs) Shrinkage of cerebellum - posture and falls Bones becoming more brittle – higher fracture risk- poorer nutrition- less chance of recovery Elderly drinkers- Typology • Early Onset- ‘Survivors’- life span of regular dependent drinker is on average shorter by 1015 years • Late Onset- ‘Reactors’- often responding to traumatic events (loss, insomnia, pain, retirement). • Intermittent ‘Binge’ drinkers- sometimes drink in excess to a level that may cause problem Age Specific Interventions • Screening – MAST G rather than Audit • Meals and Medication planning times rather than Drink Diaries • Combating isolation rather than trauma • Home visits/mobile services rather than site based • HP towards dementia, nutrition, osteo and cardiac, hepat. probs Alcohol use disorders Alcohol Dependence”: drinking above safe levels & experiencing harm & symptoms of alcohol dependence Harmful Drinking: drinking above safe levels and experiencing harm Hazardous Drinking: people drinking above recognised safe levels but not yet experiencing harm Barriers to harm reduction What does it matter at this age? It’s not a problem It’s not worth doing anything about it Belief in positive health benefits? Inadequate screening & reporting Masked by co-morbid illness Age group less likely to disclose Effects subtle & easily missed Two year pilot projects in KC and HF Design and commissioning/ aims Not a priority- wisdom of DAAT commissioners – add on to sm services rather than a priority for older peoples commissioners Increase screening capacity in older persons services Reduce alcohol related hospital admissions Identify potential need within specialist alcohol service Scope Summary of findings 67% male Missed appointments extremely low Age specific tools overwhelmingly more useful Harm reduction expressed treatment goal unusually easily acheived and attained – treatment compliance high 91% drink at home alone 62% drinking 50+ units pw 80% admitted to hospital in previous 6 months 80% treated by GP for depression Previous contact with alcohol services: 23% Hospital admissions Snapshot • Of 30 clients in one quarter six months prior to assessment – 21 (70%) presented to A&E 41 times – 18 (60%) were admitted to hospital for total of ‹181 bed nights. (excluding elective) (81k) • Six months post – 0 (with two not known) • 81-15=66k + A&E, wellbeing and quality of life (per quarter) Reasons for alcohol use Unresolved emotional difficulties from past Pain & physical illness Changes in circumstances/ adverse event Loneliness & isolation Bereavement Loss of status in the community Every man desires to live long, but no man wishes to be old. Jonathan Swift Invention is the talent judgment is of age. of youth, as Jonathan Swift You call an alcoholic someone you do not like when they drink as much as you do. Dylan Thomas