Post on 06-Jan-2016
description
transcript
Reaching out to older drinkers:
- a new practice model
Greg Scott
9 March 2010
An alcoholic is someone you don't like whoAn alcoholic is someone you don't like who
drinks as much as you do.drinks as much as you do.
Dylan Thomas
Every man desires to live long,Every man desires to live long,
but no man wishes to be old.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
ChangingChanging patterns of alcohol patterns of alcohol consumptionconsumption
Past experience indicates that alcohol Past experience indicates that alcohol consumption decreases with age, but recent consumption decreases with age, but recent patterns of behaviour may change due to patterns of behaviour may change due to ageing of the ‘baby boomers’ generation who ageing of the ‘baby boomers’ generation who have traditionally had more permissive have traditionally had more permissive attitudes towards alcohol and high level of attitudes towards alcohol and high level of consumption than earlier generations.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 vulnerabilitiesUnique vulnerabilities Metabolism slows down with ageMetabolism slows down with age
Lower body massLower body mass
Lower proportion of water in a bodyLower proportion of water in a body
Decreased hepatic blood flow- liver will receive more damageDecreased hepatic blood flow- liver will receive more damage
Interaction with other medical conditions and interaction of alcohol Interaction with other medical conditions and interaction of alcohol with medication taken as a treatment of those conditionswith medication taken as a treatment of those conditions
Inefficiency of liver enzymes- alcohol broken down inefficientlyInefficiency of liver enzymes- alcohol broken down inefficiently
Vulnerability to alcohol related harm
Psycho- social challenges of ageing and impact of alcohol (isolation, Psycho- social challenges of ageing and impact of alcohol (isolation, depression, memory deterioration, change of role, food preparation skills, depression, memory deterioration, change of role, food preparation skills, opportunities, nutritional needs)opportunities, nutritional needs)
Shrinkage of cerebellum - posture and fallsShrinkage of cerebellum - posture and falls
Bones becoming more brittle – higher fracture risk- poorer nutrition- less Bones becoming more brittle – higher fracture risk- poorer nutrition- less chance of recoverychance 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
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
The Pilot..
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
ScreeningScreening
Identifying the problem is the first step towards Identifying the problem is the first step towards resolving itresolving it
Older people are at higher risk of harm and are better Older people are at higher risk of harm and are better respondents to treatment, but failure to screen may respondents to treatment, but failure to screen may lead to less frequent access to it.lead to less frequent access to it.
Low threshold interventions delivered early alongside Low threshold interventions delivered early alongside general health promotion and in conjunction with other general health promotion and in conjunction with other medical treatments are likely to be effective.medical treatments are likely to be effective.
AssessmentAssessment
Substance abuse screening instrumentsSubstance abuse screening instruments Special assessmentsSpecial assessments Functional abilitiesFunctional abilities Co-morbid disordersCo-morbid disorders Physical co morbiditiesPhysical co morbidities Psychiatric co-morbiditiesPsychiatric co-morbidities Cognitive impairments (dementia, delirium and other)Cognitive impairments (dementia, delirium and other) Affective disordersAffective disorders Sleep disordersSleep disorders
AssessmentAssessment
Substance abuse screening instrumentsSubstance abuse screening instruments Special assessmentsSpecial assessments Functional abilitiesFunctional abilities Co-morbid disordersCo-morbid disorders Physical co morbiditiesPhysical co morbidities Psychiatric co-morbiditiesPsychiatric co-morbidities Cognitive impairments (dementia, delirium and other)Cognitive impairments (dementia, delirium and other) Affective disordersAffective disorders Sleep disordersSleep disorders
Co-morbidityCo-morbidity
Hip fracturesHip fractures Blood pressureBlood pressure Gastric problemsGastric problems ConstipationConstipation MalnutritionMalnutrition StrokeStroke DepressionDepression Isolation and poor social functioningIsolation and poor social functioning Reduced/ impaired mobilityReduced/ impaired mobility DrivingDriving
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
info@foundation66.org.uk
Foundation66 7 Holyrood St
London SE1 2EL 020 7234 9940