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Alcohol Misuse In Older Adults

Alcohol Misuse In Older Adults. Our invisible addicts. EUROPEAN DISEASE BURDEN ATTRIBUTABLE TO SELECTED LEADING RISK FACTORS (2000). Number of Disability-Adjusted Life Years (000s). ‘SENSIBLE LIMITS’ (‘HAZARDOUS/HARMFUL’) (Royal Colleges 1995).

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Alcohol Misuse In Older Adults

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  1. Alcohol Misuse In Older Adults Our invisible addicts

  2. EUROPEAN DISEASE BURDEN ATTRIBUTABLE TO SELECTED LEADING RISK FACTORS (2000) Number of Disability-Adjusted Life Years (000s)

  3. ‘SENSIBLE LIMITS’ (‘HAZARDOUS/HARMFUL’) (Royal Colleges 1995) >21 Units per week (men) & >14 per week (women) 1990 2009 % of men 65+ 14 20 % of women 65+ 5 10 (Office of National Statistics)

  4. ALCOHOL DEPENDENCE SYNDROME Fewer than 5% of community residents 15%of older medical in-patients 42%of older homeless men

  5. Alcohol-related mortality in men - London (Office of National Statistics) 1991-1997 1998-2004 Men aged 75+21.7/100,00025.7/100,000 Alcohol-related mortality in men - Southwark (Office of National Statistics) 2008-2010 Men aged 75+64.9/100,000

  6. LOCAL CMHT DATA Prospective study of CMHT referrals from Jan - Dec 02 1 in 7 people with depression had alcohol dependence

  7. OBSERVATIONS IN PEOPLE DRINKING ABOVE ‘SENSIBLE’ LIMITS • 43% showed ICD ‘alcohol dependence syndrome’ • 21% showed ‘harmful use of alcohol’ • 71% had suffered physical problems • 57% admitted to MH Ward or presented to A&E

  8. PEOPLE AGED 65 AND OVER PROJECTED POPULATION OF ENGLAND 2001-2031

  9. Gender differences in older people Women with alcohol misuse more likely to: • Be widowed/separated/divorced • Have spouse with alcohol misuse • Have history of depression • More negative effects from alcohol • Take psychotropic medication

  10. Characteristics of early vs late-onset problem drinkers Early onset (65%) Late onset (35%) Age varies (<25, 40, 45) Age varies (>55, 60, 65) Men > women Women > men Lower socioeconomic status Higher socioeconomic status Stressors common Stressors common Family History likely Family History unlikely Legal/Work problems Problems with daily routine Chronic medical illness Acute medical illness Amnestic Syndrome Alcohol-related dementia Less treatment compliance Greater treatment compliance

  11. Alcohol interactions in older adults Warfarin Antihistamines Benzodiazepines Aspirin Acid reducing drugs Opiate containing painkillers Antibiotics Drugs for diabetes Paracetamol

  12. Alcohol and the body- consequences for older people Decreased lean body mass Decreased total body water Decreased level of liver enzyme that breaks down alcohol • Higher blood alcohol concentration than younger people, for given number of units

  13. Effect of physical health status • Threshold for ‘at risk’ use decreases with age • Higher risk of other diseases (e.g. hypertension, diabetes, dementia) • Body sway increases with ‘sensible drinking’ and normal blood alcohol level

  14. Activities of daily living and alcohol misuse Shopping Using public transport/driving Taking medication Cooking Other housework Managing finances Drinking > 8 units per week associated with impairment in domestic activities

  15. Chronic Alcohol Use Cognitive disorders CVAPsychosis Depression Head, Neck, GI cancers Neuropathy Anaemia Nutritional Deficiencies Coronary Artery Disease CardiomyopathyArrhythmiaHypertension Stroke Liver Disease Cirrhosis Stomach ulcer Gastritis Pancreatitis Diabetes Duodenal ulcer

  16. NORMAL BRAIN WERNICKE’S ENCEPHALOPATHY

  17. HIGH RISK GROUPS • Homelessness • Past harmful/hazardous drinking • Recent bereavement • Depression • Social isolation • Retirement • Immobility

  18. 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’ Care of the Elderly physicians less likely than general physicians to screen for alcohol use UNDER-REPORTING Seen as a moral weakness Stigmatising

  19. BARRIERS TO IDENTIFICATION AND TREATMENT II MIS-ATTRIBUTION Identifying alcohol-related symptoms as physical illness/ depression/cognitive impairment Poorer detection of drinking in: Women Higher levels of education Higher social class Widows STEREOTYPING

  20. MENTAL DISORDER SUICIDE DRUG INTERACTIONS ALCOHOL ELDER ABUSE ACCIDENTS (FALLS) PHYSICAL DISORDERS SELF NEGLECT

  21. RATING SCALES • Commonly not used in primary AND secondary care, because of • Time constraints/competing demands • Insufficient Training • Limited evidence for treatment • ‘Traditional Rating Scales’ lack sensitivity and validity, particularly in the elderly

  22. Alcohol Screening For Older Adults (SMAST-G)

  23. IMPLICATIONS FOR EXISTING SERVICES 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

  24. Recommendations from Our Invisible Addicts • Improved detection by primary and secondary care • Improved access to treatment • Improved training of health professionals • Better partnerships between statutory and voluntary sectors • Better provision, e.g. for alcohol related brain injury • Prioritisation in government policy • Prioritisation for research into extent of problem, detection, treatment and health/social care outcomes

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