Alcohol and Older People Radomir Lazarevich, Area Manager 29 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 mil (16% raise from ’71.), projected 14 mil by 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 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 admissions Snapshot 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 Jonathan Swift You call an alcoholic someone you do not like when they drink as much as you do. Dylan Thomas