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