Alcohol Misuse In Older Adults Alcohol Misuse In Older Adults Our invisible addicts.

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Alcohol Misuse In Alcohol Misuse In Older Adults Older Adults Our invisible addicts

Transcript of Alcohol Misuse In Older Adults Alcohol Misuse In Older Adults Our invisible addicts.

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Alcohol Misuse In Alcohol Misuse In Older AdultsOlder Adults

Our invisible addicts

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0 5000 10000 15000 20000

Illicit drugs

Physical inactivity

Fruit and vegetable intake

High Body Mass Index

Cholesterol

Alcohol

Tobacco

Blood pressure

EUROPEAN DISEASE BURDEN ATTRIBUTABLE TO SELECTED LEADING RISK FACTORS (2000)

Number of Disability-Adjusted Life Years (000s)

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1990 2009

% of men 65+ 14 20

% of women 65+ 5 10

(Office of National Statistics)

>21 Units per week (men) & >14 per week (women)

‘SENSIBLE LIMITS’ (‘HAZARDOUS/HARMFUL’) (Royal Colleges 1995)

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42% of older homeless men

15% of older medical in-patients

Fewer than 5% of community residents

ALCOHOL DEPENDENCE SYNDROME

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1991-1997 1998-2004

Men aged 75+ 21.7/100,000 25.7/100,000

Alcohol-related mortality in men - London (Office of National Statistics)

2008-2010

Men aged 75+ 64.9/100,000

Alcohol-related mortality in men - Southwark (Office of National Statistics)

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LOCAL CMHT DATALOCAL CMHT DATA

1 in 7 people with depression had alcohol dependence

Prospective study of CMHT referrals from Jan - Dec 02

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OBSERVATIONS IN PEOPLE OBSERVATIONS IN PEOPLE DRINKING ABOVE ‘SENSIBLE’ DRINKING ABOVE ‘SENSIBLE’

LIMITSLIMITS

• 43% showed ICD ‘alcohol dependence syndrome’

• 71% had suffered physical problems

• 57% admitted to MH Ward or presented to A&E

• 21% showed ‘harmful use of alcohol’

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PEOPLE AGED 65 AND OVER

PROJECTED POPULATION OF ENGLAND 2001-2031

7.8

16

8.6

17

10.2

19

12

22

0

5

10

15

20

25

Population of England (million) % of Total

2001

2011

2021

2031

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Gender differences in Gender differences in older peopleolder people

Women with alcohol misuse more Women with alcohol misuse more likely to:likely to:

Be widowed/separated/divorcedBe widowed/separated/divorced Have spouse with alcohol misuseHave spouse with alcohol misuse Have history of depressionHave history of depression More negative effects from alcoholMore negative effects from alcohol Take psychotropic medicationTake psychotropic medication

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Early onset (65%) Late onset (35%)

Age varies (<25, 40, 45) Age varies (>55, 60, 65)Men > women Women > menLower socioeconomic status Higher socioeconomic status Stressors common

Stressors common Family History likely Family History unlikelyLegal/Work problems Problems with daily routineChronic medical illness Acute medical illnessAmnestic Syndrome Alcohol-related dementiaLess treatment compliance Greater treatment compliance

Characteristics of early vs late-onset problem drinkers

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Warfarin

Antihistamines

Benzodiazepines

Aspirin

Acid reducing drugs

Opiate containing painkillers

Antibiotics

Drugs for diabetes

Paracetamol

Alcohol interactions in older adults

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Alcohol and the body- consequences for Alcohol and the body- consequences for older peopleolder people

Decreased lean body mass Decreased lean body mass

Decreased total body waterDecreased total body water

Decreased level of liver enzyme that breaks Decreased level of liver enzyme that breaks down alcoholdown alcohol

Higher blood alcohol concentration Higher blood alcohol concentration than younger people, for given than younger people, for given number of unitsnumber of units

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Effect of physical health Effect of physical health statusstatus

Threshold for ‘at risk’ use decreases Threshold for ‘at risk’ use decreases with agewith age

Higher risk of other diseases Higher risk of other diseases

(e.g. hypertension, diabetes, dementia)(e.g. hypertension, diabetes, dementia)

Body sway increases with ‘sensible Body sway increases with ‘sensible drinking’ drinking’ and normal blood alcohol and normal blood alcohol levellevel

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Shopping Using public transport/driving Taking medicationCooking Other houseworkManaging finances

Activities of daily living and alcohol misuse

Drinking > 8 units per week associated with impairment in domestic activities

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Chronic Alcohol UseChronic Alcohol Use

Liver DiseaseLiver DiseaseCirrhosisCirrhosis

Coronary Artery DiseaseCoronary Artery DiseaseCardiomyopathyCardiomyopathyArrhythmiaArrhythmiaHypertension Hypertension StrokeStroke

Duodenal ulcerDuodenal ulcer

Cognitive disordersCognitive disordersCVACVAPsychosisPsychosisDepressionDepression

PancreatitisPancreatitisDiabetesDiabetes

Head, Neck, GI cancersHead, Neck, GI cancers

Stomach ulcerStomach ulcerGastritisGastritis

NeuropathyNeuropathyAnaemia Anaemia Nutritional DeficienciesNutritional Deficiencies

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NORMAL BRAIN WERNICKE’S ENCEPHALOPATHY

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• Homelessness

• Recent bereavement

• Depression

• Social isolation

HIGH RISK GROUPS

• Past harmful/hazardous drinking

• Retirement

• Immobility

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BARRIERS TO IDENTIFICATION AND TREATMENT I

AGEISM ‘It’s all he/she has in life’

‘Always been a poor sleeper’

‘Can be a bit fussy with food’

UNDER-REPORTING Seen as a moral weakness

Stigmatising

Care of the Elderly physicians less likely than general physicians to screen for alcohol use

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BARRIERS TO IDENTIFICATION AND TREATMENT II

MIS-ATTRIBUTION Identifying alcohol-related symptoms as physical illness/depression/cognitive impairment

STEREOTYPING Poorer detection of drinking in: Women Higher levels of educationHigher social classWidows

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SUICIDE

ACCIDENTS(FALLS)

SELF NEGLECT

PHYSICALDISORDERS

MENTALDISORDER

ALCOHOL

ELDER ABUSE

DRUGINTERACTIONS

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RATING SCALES

Commonly not used in primary Commonly not used in primary AND secondary care, because ofAND secondary care, because of

• Time constraints/competing Time constraints/competing demandsdemands• Insufficient TrainingInsufficient Training• Limited evidence for treatmentLimited evidence for treatment

‘‘Traditional Rating Scales’ lack Traditional Rating Scales’ lack sensitivity and validity, particularly sensitivity and validity, particularly in the elderlyin the elderly

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Alcohol Screening For Older Adults (SMAST-G)

1. Underestimates amount of alcohol

2. Misses meals

3. Uses alcohol to decrease tremors

4. Memory blackouts after drinking alcohol

5. Drinking to relax/calm nerves

6. Drinking to take mind off problems

7. Drinking after significant loss

8. Concern about drinking from doctor/nurse

9. Making rules to manage drinking

10.Drinking to ease loneliness

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IMPLICATIONS FOR EXISTING IMPLICATIONS FOR EXISTING SERVICESSERVICES

Extrapolating prevalence data for people aged 65 and above:

OVER 500 men and 300 women in both Lewisham and Southwark

with a diagnosis of Alcohol Dependence Syndrome

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Recommendations from Recommendations from Our Our Invisible AddictsInvisible Addicts

Improved detection by primary and secondary careImproved detection by primary and secondary care Improved access to treatmentImproved access to treatment Improved training of health professionals Improved training of health professionals Better partnerships between statutory and Better partnerships between statutory and

voluntary sectorsvoluntary sectors Better provision, e.g. for alcohol related brain Better provision, e.g. for alcohol related brain

injuryinjury Prioritisation in government policyPrioritisation in government policy Prioritisation for research into extent of problem, Prioritisation for research into extent of problem,

detection, treatment and health/social care detection, treatment and health/social care outcomesoutcomes

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