Transcript Slide 1
Reaching out to older drinkers:
- a new practice model
Greg Scott
9 March 2010
An alcoholic is someone you don't like who
drinks as much as you do.
Dylan Thomas
Every man desires to live long,
but no man wishes to be old.
Jonathan Swift
Some basic background UK
Alcohol consumption rose by 60%: (1970 – 2006)
Affordability of alcohol doubled (1970 – 2001)
Most popular drinking venue is the home
ANARP (2004) excluded the over 65s
Models of Care for Alcohol Misusers
Review of Effectiveness: 1 reference for older people
Focus on Older People (65+)
Little published research or data
Demographic changes
Levels of alcohol related harm
Vulnerability to alcohol related harm
Alcohol & older people
“Wet Generation” born after World War II
Older men drink nearly as often as all adults
84% increase in cost of treating alcohol related harm
Currently > 50% total NHS spend on alcohol related
harm
75% increase alcohol related hospital admissions
Changing patterns of alcohol
consumption
Past experience indicates that alcohol
consumption decreases with age, but recent
patterns of behaviour may change due to
ageing of the ‘baby boomers’ generation who
have traditionally had more permissive
attitudes towards alcohol and high level of
consumption than earlier generations.
Changes in alcohol related admissions
for 65+
% increase 2002 - 2007
Malignant neoplasm of oesophagus
6.6
Fall injuries
19.3
Liver disease
45.9
Epilepsy and Status epilepticus
51.8
Cardiac arrhythmias
70.9
Mental / behavioural disorders
76.9
Hypertensive diseases
119.4
Source: NHS Information Centre for Health & Social Care
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
Vulnerability to alcohol related harm
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
Mistaken for common physical or psychiatric conditions
Alcohol – medication interactions
Inadequate screening & reporting
Age group less likely to disclose
Risk of abuse and neglect
Early onset:
Describes those who have a lifelong pattern of
drinking, have probably been alcoholic all their
life, and are now elderly.
More likely to have chronic alcohol-related
medical problems such as cirrhosis, organic
brain syndrome, and co-morbid psychiatric
disorders.
Late onset:
Describes those who have become alcoholic in their
drinking pattern for the first time late in life.
Often triggered by a stressful life event.
Generally represented by milder cases with fewer
accompanying medical problems.
More amenable to treatment, more likely to have
spontaneous recovery
“Wiser Drinking”
Kensington & Chelsea pilot 2008/9
Aims:
Assess need for treatment services
Increase screening capacity in older persons services
Reduce alcohol related hospital admissions
Identify potential need for specialist alcohol service
Provision for treatment capacity
Service re-commissioned 2009/10
Older People’s Service
Specialist Service embedded in Tier 2
Alcohol Service
Providing training for other services
Outreach and site based
The Pilot..
Working with local services to build capacity
Raise awareness of alcohol and ageing
Training in use of screening tool
Individual case work
Harm reduction advice and support
Pathways between geriatric & specialist alcohol services
Referral to treatment
Support accessing health & care services
Liaison with carers
Referrals
70% women
Oldest: 87 years
All had their alcohol delivered to home
Half drinking 70+ units pw
40% drinking over 50 units
80% admitted to hospital in previous 6 months
80% treated by GP for depression
Previous contact with alcohol services: 3
Screening
Identifying the problem is the first step towards
resolving it
Older people are at higher risk of harm and are better
respondents to treatment, but failure to screen may
lead to less frequent access to it.
Low threshold interventions delivered early alongside
general health promotion and in conjunction with other
medical treatments are likely to be effective.
Assessment
Substance abuse screening instruments
Special assessments
Functional abilities
Co-morbid disorders
Physical co morbidities
Psychiatric co-morbidities
Cognitive impairments (dementia, delirium and other)
Affective disorders
Sleep disorders
Assessment
Substance abuse screening instruments
Special assessments
Functional abilities
Co-morbid disorders
Physical co morbidities
Psychiatric co-morbidities
Cognitive impairments (dementia, delirium and other)
Affective disorders
Sleep disorders
Co-morbidity
Hip fractures
Blood pressure
Gastric problems
Constipation
Malnutrition
Stroke
Depression
Isolation and poor social functioning
Reduced/ impaired mobility
Driving
Reasons for alcohol use
Unresolved emotional difficulties from past (53%)
Loneliness & isolation (23%)
Bereavement (10%)
Loss of status in the community (9%)
Ill prepared for retirement (9%)
Findings
Older people receptive to interventions
Enthusiastically received by fellow professionals, the
drinkers (and the media)
Need for health specialists in alcohol & ageing
Evidence of unmet demand for alcohol interventions
Implications
Evidence of significant unmet need for services
Demographic projections suggest rising need for
alcohol interventions with 65+ age group
Need to develop data and experience
Older people appear to welcome appropriate help
Alcohol related harms are often reversible
Next steps
More of the same
More similar
Partnership with a University & another charity
Replicate the pilot to see if findings confirmed
Development of evidence base
How should we address alcohol
use amongst older people?
More research & better data
Guidance on development of local treatment pathways
Cross-authority co-operation to develop services
Greater awareness amongst health & social care staff
Greater attention to drinking habits
Some increase in treatment capacity
www.foundation66.org.uk
[email protected]
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London SE1 2EL
020 7234 9940