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• GP’s• A&E admissions / Nurse Liaison• Housing• Social Services

Vulnerability to alcohol related harm

• Reduced tolerance to effects • Mistaken for common physical or psychiatric conditions• Alcohol – medication interactions• Inadequate screening & reporting• Masked by co-morbid physical or psychiatric illness• Ageism• Belief in positive health benefits?• Age group less likely to disclose• Risk of abuse and neglect

Engagement

• Not presenting to services• Home visits yielding good outcomes• Good outcomes generally, more

resources, life experience etc.

Education• 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

source: NHS Information centre for Health and Social Care

Changes in alcohol related admissions for 65+

% increase 2002 - 2007Malignant neoplasm of oesophagus 6.6Fall injuries 19.3Liver disease 45.9Epilepsy and Status epilepticus 51.8Cardiac arrhythmias 70.9Mental / behavioural disorders 76.9Hypertensive diseases119.4

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

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?

• 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

References & other background info:• 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