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)
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Most popular drinking venue is the home
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ANARP (2004) excluded the over 65s
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Models of Care for Alcohol Misusers
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Review of Effectiveness: 1 reference for older people
Focus on Older People (65+)
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Little published research or data
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Demographic changes
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Levels of alcohol related harm
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Vulnerability to alcohol related harm
Alcohol & older people
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“Wet Generation” born after World War II
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Older men drink nearly as often as all adults
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84% increase in cost of treating alcohol related harm
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Currently > 50% total NHS spend on alcohol related
harm
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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”
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Kensington & Chelsea pilot 2008/9
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Aims:
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Assess need for treatment services
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Increase screening capacity in older persons services
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Reduce alcohol related hospital admissions
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Identify potential need for specialist alcohol service
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Provision for treatment capacity
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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..

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Working with local services to build capacity
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Raise awareness of alcohol and ageing
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Training in use of screening tool
Individual case work
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Harm reduction advice and support
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Pathways between geriatric & specialist alcohol services
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Referral to treatment
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Support accessing health & care services
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Liaison with carers
Referrals
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70% women
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Oldest: 87 years
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All had their alcohol delivered to home
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Half drinking 70+ units pw
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40% drinking over 50 units
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80% admitted to hospital in previous 6 months
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80% treated by GP for depression
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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
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Unresolved emotional difficulties from past (53%)
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Loneliness & isolation (23%)
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Bereavement (10%)
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Loss of status in the community (9%)
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Ill prepared for retirement (9%)
Findings
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Older people receptive to interventions
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Enthusiastically received by fellow professionals, the
drinkers (and the media)
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Need for health specialists in alcohol & ageing
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Evidence of unmet demand for alcohol interventions
Implications
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Evidence of significant unmet need for services
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Demographic projections suggest rising need for
alcohol interventions with 65+ age group
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Need to develop data and experience
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Older people appear to welcome appropriate help
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Alcohol related harms are often reversible
Next steps
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More of the same
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More similar
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Partnership with a University & another charity
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Replicate the pilot to see if findings confirmed
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Development of evidence base
How should we address alcohol
use amongst older people?
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More research & better data
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Guidance on development of local treatment pathways
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Cross-authority co-operation to develop services
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Greater awareness amongst health & social care staff
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Greater attention to drinking habits
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Some increase in treatment capacity
www.foundation66.org.uk
[email protected]
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