James Morris Academy Programme Lead 10 th February 2010

1. Specialist approaches in alcohol treatment for the elderly James Morris Academy Programme Lead 10th February 2010

2. Aims • Do we need specialist approaches? • Explore some of the existing models of specialist alcohol treatment for older people • Identify some of the key issues and challenges

3. Do we need specialist treatment approaches for older people? • Alcohol use/consumption affects older people differently! • Different range of needs and sensitivities • Accessibility! • Raising recognition of the issue & challenging perceptions • Integrated older people services are best? • Does not need to be specific services

4. Stepped Care approach ‘Signs for improvement: commissioning interventions to reduce alcohol-related harm’ DoH 2009

5. Remember the IAS fact sheet • Early-Onset drinkers or ‘Survivors’ are those with a continuing problem with alcohol which developed in earlier life. • It is thought that 2/3rds of elderly problem drinkers have had an early onset of alcohol misuse. • These drinkers are likely to need more intensive support than brief interventions

6. What does MoCAM say? • B4.8 "Community settings are preferred for the treatment of the majority of alcohol misusers, both because individuals need to learn how to change their drinking in their normal social environment and because it is cost-effective. Those individuals who are unable to leave the home or who would have difficulties attending a specialist agency – for example older people, disabled people and parents with childcare responsibilities – may need specialist alcohol treatment in their own homes or other community settings."

7. Model 1: Dual Diagnosis amongst older people in Southwark Overview • Mental Health of Older Adults team (MHOA) • Open Access service • Dual Diagnosis provision established within existing resources • Lead by team consultant, Dr Tony Rao

8. North Southwark profile • Inner London borough • ~13,000 over 65s • Large ex-dock worker population • Significant older Irish population

9. Model 1: Dual Diagnosis amongst older people in Southwark Need? • High alcohol-related hospital admissions from the locality • High overall referral numbers to MHOA • Between 10-20% of referrals had dual diagnosis/alcohol misuse • Onward referrals were often not accepted – people were caught between services and conditions often worsened

10. Model 1: Dual Diagnosis amongst older people in Southwark Need? • In 2003 all 14 people at one point had dual diagnosis for alcohol misuse: • 43% showed ICD alcohol dependence syndrome • 21% showed ‘harmful use of alcohol’ 21% showed ‘harmful use of alcohol’ • 71% suffered physical problems • 57% admitted to MHOA ward or presented to A&E

11. Model 1: Dual Diagnosis amongst older people in Southwark Response: • Team consultant (MSc in addictions) to care-coordinate all dual diagnosis cases • Delivery of screening for alcohol followed by brief interventions and psychosocial interventions as appropriate • Key partnerships with Older Adults services including housing and Irish Pensioners Project • Delivery of level 1 (generic) Dual Diagnosis training across the trust, as part of DD strategy

12. Model 1: Dual Diagnosis amongst older people in Southwark Outcomes: • Between 2005 to 2009, there was a 90% reduction in alcohol-related hospital admissions for Older People from north Southwark • However alcohol harm still appears to be rising and there has been an 80% increase in Dual Diagnosis instances on the caseload

13. Model 1: Dual Diagnosis amongst older people in Southwark Tony, what are the key components? • Improved training in screening and referral • increased awareness in primary care and addictions services • improved relationships with voluntary agencies

14. Model 2: Older People’s outreach service in Hammersmith & Fulham Overview • Foundation 66 specialist alcohol service employ 2 specialist older people & alcohol posts • Placed within Adult Social Services Drug and Alcohol Team • Outreach model of weekly home visits for identified clients with alcohol needs

15. Model 2: Older People’s outreach service in Hammersmith & Fulham Delivery • Senior worker and assistant practitioner carry out weekly home visits based on full assessment and support plans • Includes triage and referral and joint working with a wide range of services • Specific training delivered to housing managers, care managers, healthcare workers and volunteers

16. Model 2: Older People’s outreach service in Hammersmith & Fulham Outcomes • The service is proving very popular with clients and partners • Anecdotal evidence shows that screening and brief interventions are proving effective

17. Model 3: Older People’s day service in County Durham Overview • ‘The Whitehouse project’ • Day service for older adults with alcohol needs • Referral for alcohol-related hospital admissions • Free transport collects and returns people to their homes

18. Model 3: Older People’s day service in County Durham Service user needs • Liver issues • Poor mental health • Low moods • History of Self harm • Poor nutrition • Poor mobility – frail • Cognition problems due to premature ageing • Lonely & isolation • Family respite Provider/commissioner issues & needs • Hospital Admissions target • Identified gap/ Community Alcohol Service pathway • Better understanding • Consultant issues • Bed blocking • Younger patients • Family support • Constant revolving door client group • Costs to the PCT

19. Model 3: Older People’s day service in County Durham Delivery • Existing service of Durham Alliance Community Care (DACC) providing day service for older adults • Specific referral pathway from hospital Alcohol Liaison Nurse/Community Alcohol Service

20. Model 3: Older People’s day service in County Durham Outcomes • Undergoing evaluation but: • Staff ‘When you come to the White House project there is no pressure. As a group we have gelled and we can get strength from each other and from the staff’ • Peer/Mutual support ‘There is something powerful about seeing others do well and get healthy – it makes you think if they can do it then why not me?’ • Families ‘My family is over the moon’   ‘I think that my wife feels she gets a break’

21. ‘Counselling people with dementia and alcohol problems’ Fox 2008 • Particular risk of alcohol harm and problems amongst dementia sufferers • Social isolation a significant factor • Responses should include • Early identification • Individualised care and support strategy • Collaborative working essential • Innovative approaches recognising cognitive impairments

22. Further info& contacts www.alcoholacademy.net www.alcoholpolicy.net James Morris, AERC Alcohol Academy james@alcoholacademy.net 0207 450 2930