Working with Older drinkers:
- the Hidden Problem
Greg Scott, Sean Dudley,
Hammersmith and Fulham Older People’s service,
20 May 2010
Alcohol & older people
• 17% of population is over 65
• Alcohol related deaths in UK doubled form 1991-2005
• Highest death rate from alcohol among those aged 55-7
• Older Men drink nearly as often as all adults
Detection
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GP’s
A&E admissions / Nurse Liaison
Housing
Social Services
Vulnerability to alcohol related harm
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Reduced tolerance to effects
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Mistaken for common physical or psychiatric conditions
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Alcohol – medication interactions
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Inadequate screening & reporting
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Masked by co-morbid physical or psychiatric illness
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Ageism
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Belief in positive health benefits?
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Age group less likely to disclose
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Risk of abuse and neglect
Engagement
• Not presenting to services
• Home visits yielding good outcomes
• Good outcomes generally, more
resources, life experience etc.
Education
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Alcohol awareness is key
Family members
GP’s
Housing workers
Barriers
• Barnes Ward research in Brighton:
• Practitioners:
• Difficulties in knowing how to approach the
issue with older people
• Inability of older people to acknowledge
problem
• Lack of appropriate services for referral
• The issue of ‘rights’ – should we intervene?
Myths about alcohol and older people
• At your age what does it matter?
• You can’t teach an old dog new tricks!
• The issue of rights – no right to intervene
Changes in alcohol related admissions
for 65+
% increase 2002 - 2007
Malignant neoplasm of oesophagus
Fall injuries 19.3
Liver disease 45.9
Epilepsy and Status epilepticus 51.8
Cardiac arrhythmias70.9
Mental / behavioural disorders
76.9
Hypertensive diseases
119.4
source: NHS Information centre
for Health and Social Care
6.6
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
Hammersmith and Fulham Older
Persons’ Alcohol Service
One Year On
Out of 49 clients fully assessed by
the service between June 09 and
March 2010
• 42 drank at home alone
• 19 bought alcohol direct from shops
• 8 had alcohol delivered to their home
• 15 had alcohol bought for them by carers or relatives
• 27 clients drank in excess of 70 units per week
Reasons for not accessing services
• 30 out of 49 clients had not accessed services
previously
• 27 clients were physically unable to access building
based services easily
• 15 clients said they would feel intimidated or
stigmatised by accessing alcohol services
• 7 clients said they did not feel alcohol was an issue in
their lives
Reasons for drinking
• 22 clients stated social isolation and loneliness
• 19 clients stated anxiety and depression
• 8 clients said they drank very little before they retired
The Older Persons Team Response
• Essential to work alongside front line workers, carers,
family to raise awareness of issues involving alcohol
and older people
• Provide advice, information, support and training
The Training Session
• Looks at basic alcohol awareness and how alcohol
affects the older community
• Places alcohol firmly in the context of general physical
and mental well being breaking the taboo of raising the
subject
• Increases referrals to the service before the client
reaches crisis
• Encourages effective joint working
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
info@foundation66.org.uk
Foundation66
7 Holyrood St
London SE1 2EL
020 7234 9940
References & other background info:
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ANARP Alcohol Needs Assessment Research Project DH 2005
MoCAM Models of Care for Alcohol Misusers DH 2006
Review of the effectiveness of treatment for alcohol problems (NTA 2006)
Fillmore K M et al 2006 Addiction Research & Theory 14 (2) 101-132
Fillmore K M et al 2006 Addiction Research & Theory 15 (1) 35-46
Alcohol consumption among elderly EU citizens Hallgren et al 2009
National Statistics Online: Population estimates - 27 August 2009
National Statistics Online: Ageing – 27 August 2009
Robinson S and Lader D. General Household Survey 2007: Smoking and
drinking among adults, Newport Office for National Statistics 2009.
• Joseph Rowntree Foundation: Drinking in the UK: An exploration of
trends May 2009