Reaching out to older drinkers: - a new practice model Greg Scott 9 March 2010

1. Reaching out to older drinkers: - a new practice model Greg Scott 9 March 2010

3. An alcoholic is someone you don't like who drinks as much as you do. Dylan Thomas

4. Every man desires to live long, but no man wishes to be old. Jonathan Swift

5. Some basic background UK • Alcohol consumption rose by 60%: (1970 – 2006) • Affordability of alcohol doubled (1970 – 2001) • Most popular drinking venue is the home • ANARP (2004) excluded the over 65s • Models of Care for Alcohol Misusers • Review of Effectiveness: 1 reference for older people

6. Focus on Older People (65+) • Little published research or data • Demographic changes • Levels of alcohol related harm • Vulnerability to alcohol related harm

7. Alcohol & older people • “Wet Generation” born after World War II • Older men drink nearly as often as all adults • 84% increase in cost of treating alcohol related harm • Currently > 50% total NHS spend on alcohol related harm • 75% increase alcohol related hospital admissions

8. Changing patterns of alcohol consumption Past experience indicates that alcohol consumption decreases with age, but recent patterns of behaviour may change due to ageing of the ‘baby boomers’ generation who have traditionally had more permissive attitudes towards alcohol and high level of consumption than earlier generations.

9. Changes in alcohol related admissions for 65+ Source: NHS Information Centre for Health & Social Care

10. 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

11. Vulnerability to alcohol related harm • 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 • Mistaken for common physical or psychiatric conditions • Alcohol – medication interactions • Inadequate screening & reporting • Age group less likely to disclose • Risk of abuse and neglect

12. Early onset: Describes those who have a lifelong pattern of drinking, have probably been alcoholic all their life, and are now elderly. More likely to have chronic alcohol-related medical problems such as cirrhosis, organic brain syndrome, and co-morbid psychiatric disorders.

13. Late onset: • Describes those who have become alcoholic in their drinking pattern for the first time late in life. • Often triggered by a stressful life event. • Generally represented by milder cases with fewer accompanying medical problems. • More amenable to treatment, more likely to have spontaneous recovery

14. “Wiser Drinking” • Kensington & Chelsea pilot 2008/9 • Aims: • Assess need for treatment services • Increase screening capacity in older persons services • Reduce alcohol related hospital admissions • Identify potential need for specialist alcohol service • Provision for treatment capacity • Service re-commissioned 2009/10

15. Older People’s Service • Specialist Service embedded in Tier 2 Alcohol Service • Providing training for other services • Outreach and site based

16. The Pilot.. • Working with local services to build capacity • Raise awareness of alcohol and ageing • Training in use of screening tool • Individual case work • Harm reduction advice and support • Pathways between geriatric & specialist alcohol services • Referral to treatment • Support accessing health & care services • Liaison with carers

17. Referrals • 70% women • Oldest: 87 years • All had their alcohol delivered to home • Half drinking 70+ units pw • 40% drinking over 50 units • 80% admitted to hospital in previous 6 months • 80% treated by GP for depression • Previous contact with alcohol services: 3

18. Screening Identifying the problem is the first step towards resolving it Older people are at higher risk of harm and are better respondents to treatment, but failure to screen may lead to less frequent access to it. Low threshold interventions delivered early alongside general health promotion and in conjunction with other medical treatments are likely to be effective.

19. Assessment Substance abuse screening instruments Special assessments Functional abilities Co-morbid disorders Physical co morbidities Psychiatric co-morbidities Cognitive impairments (dementia, delirium and other) Affective disorders Sleep disorders

20. Assessment Substance abuse screening instruments Special assessments Functional abilities Co-morbid disorders Physical co morbidities Psychiatric co-morbidities Cognitive impairments (dementia, delirium and other) Affective disorders Sleep disorders

21. Co-morbidity Hip fractures Blood pressure Gastric problems Constipation Malnutrition Stroke Depression Isolation and poor social functioning Reduced/ impaired mobility Driving

22. Reasons for alcohol use • Unresolved emotional difficulties from past (53%) • Loneliness & isolation (23%) • Bereavement (10%) • Loss of status in the community (9%) • Ill prepared for retirement (9%)

23. Findings • Older people receptive to interventions • Enthusiastically received by fellow professionals, the drinkers (and the media) • Need for health specialists in alcohol & ageing • Evidence of unmet demand for alcohol interventions

24. 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

25. Next steps • More of the same • More similar • Partnership with a University & another charity • Replicate the pilot to see if findings confirmed • Development of evidence base

26. 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

27. www.foundation66.org.uk info@foundation66.org.uk Foundation66 7 Holyrood St London SE1 2EL 020 7234 9940