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Alcohol and Older People
Radomir Lazarevich, Area Manager29 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 10-15 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 admissionsSnapshot
• 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 of youth, as judgment is of age. Jonathan Swift
You call an alcoholic someone you do not like when they drink as much as you do.Dylan Thomas