How can older people's mental health services in the UK respond to the escalating prevalence of alcohol misuse among older adults?

Risky drinking and dual diagnosis in older people under a UK community old age psychiatry service

Purpose

The assessment of patterns in risky drinking and its association with dual diagnosis in community services for older people remains under-explored. The paper aims to discuss this issue.

Design/methodology/approach

Drinking risk using the Alcohol Use Disorders Identification Test (AUDIT) and the presence of co-existing mental disorders was examined in 190 people aged 65 and over.

Findings

In total, 24 per cent of drinkers drank above lower risk levels and 22 per cent reported binge drinking over the past 12 months. Those scoring 1 or more on the AUDIT were more likely to be male and to have greater cognitive impairment than non-drinkers and those reporting no past problems with alcohol.

Research limitations/implications

Given the limitations of the Mini Mental State Examination in the detection of alcohol related cognitive impairment (ARCI), the use of other cognitive screening instruments in larger study populations is also warranted.

Practical implications

Greater attention needs to be paid to the assessment of risky drinking in older male drinkers and those with cognitive impairment.

Originality/value

There is considerable scope for the routine detection of cognitive impairment and dementia in older people with alcohol use within mainstream mental health services, particularly in those with binge drinking. As ARCI is associated with loss of function and independence, early detection and intervention can improve health and social outcomes.

How does Older People's Drinking Appear in the Daily Work of Home Care Professionals?

Aims

In this article the authors ask how the alcohol use of elderly home care clients affects the daily work of home care professionals and how the professionals act to support the drinking client.

Methods

Semi-structured interviews with 10 home care professionals were conducted from December 2014 to February 2015 in the Helsinki metropolitan area of Finland. Everyday situations during home visits related to the clients' alcohol use were analysed according to modalities of agency of the home care professionals.

Results

The results focus on three themes raised in the interviews: supporting life management of the client, the lack of qualifications in tackling clients' drinking and the need for multi-professional collaboration. Intoxicated clients complicated the home care nurses' work and obstructed the implementation of recommendations set out to guide the professionals' operations. Care work with alcohol-using clients was particularly demanding, and the professionals were concerned about not having enough training in how to encounter elderly clients' drinking. Multi-professional collaboration with substance abuse services and emergency department personnel was called for to remedy this problem.

Conclusions

More extensive and detailed research is needed for a better picture of how clients' drinking influences home care nurses' working conditions and what kind of skills nurses need in different alcohol-related situations. Such research would have the potential to benefit clients and improve the well-being of the employees.

Alcohol screening in people with cognitive impairment: an exploratory study

OBJECTIVE

Alcohol misuse can coexist with and/or contribute to the development of cognitive impairment in the older adult population but continues to be underestimated and undetected in older people. This study aimed to examine the feasibility and acceptability of routine screening for alcohol misuse in a small sample of older people with cognitive impairment receiving services in memory clinics.

METHODS

This study employed a qualitative and exploratory design, using a convenience sample of individuals attending a memory clinic in England. Ten service users older than 65 with a diagnosis of cognitive impairment (i.e., mild cognitive impairment or dementia) took part in the study. Individuals who met inclusion criteria were invited to take part in an hour-long interview, which included the interviewer administering the alcohol screening tools. Interview transcripts were analyzed using thematic analysis.

RESULTS

Participants were able to engage with the screening tools and could, with assistance, complete them in a collaborative and timely manner without distress. All participants reported that these tools were acceptable as part of the clinic assessment. Administering the screening tools was not time-consuming or difficult, making their use feasible within the memory clinic setting. While there were some challenges (e.g., arithmetic, recall, language problems), these challenges could be overcome with the aid of the person administering the screening tool using standardized techniques for assessment administration.

CONCLUSIONS

Routine screening for alcohol misuse in older people with cognitive impairment receiving services in memory clinics is feasible and acceptable. The process of completing alcohol screening tools with older adults receiving services at memory clinics may increase awareness of the potential impact of alcohol on cognitive functioning and provide practitioners with an opportunity to educate service users about the ways that their drinking is affecting their memory. Several techniques to facilitate completion of screening tools were identified. Future research should evaluate the reliability and validity of alcohol screening tools with older people through corroborating screening results with other assessment methods.

Exploring risky drinking and knowledge of safe drinking guidelines in older adults

BACKGROUND

Risky drinking criteria in older adults lack consistency across the literature. The variable definitions of risk have contributed in part, to widely differing prevalence estimates for risky drinking, ranging from 1% to 15%.

OBJECTIVES

(1) To identify the prevalence of different types of risky drinking by applying several different criteria, (2) To investigate whether older adults have knowledge of the National Health and Medical Research Council recommended guidelines for safe drinking.

METHODS

The study population consisted of community dwelling past-year drinkers (n = 292) aged ≥ 60 years. Participants completed a postal survey on alcohol consumption using the AUDIT-C.

RESULTS

Applying multiple risky drinking criteria indicated that 6.6% to 31.7% of women and 21.6% to 44.8% of men were risky drinkers. Men were more likely than women to have inaccurate knowledge of the NHMRC guidelines, and nearly 59.2% of men who exceeded 14 drinks per week reported either not knowing the recommended limits or reported limits that exceeded the guidelines. Conclusions/Importance: A substantial number of older men drank at risky levels and overestimated safe drinking limits. Greater education on the vulnerability to alcohol-related harm together with greater screening practice by health professionals and service providers is recommended. Findings illustrate how different risky drinking criteria vary in their average AUDIT-C scores, with the NHMRC criteria showing greater average scores compared to other criteria. RESULTS also imply that cutoff scores of ≥ 4 for women and ≥ 6 for men are consistent with a range of risky drinking criteria in older adults.

Alcohol related brain damage – a case of neglect?

Purpose

– The purpose of this paper is to argue that alcohol-related brain damage (ARBD) is a neglected problem. ARBD is a term that has begun to be used over the past decade to describe prolonged cognitive impairment caused by alcohol use, including Wernicke's encephalopathy and Korsakoff syndrome, alcohol dementia and alcohol-related brain injury.

Design/methodology/approach

– The paper provides an overview of ARBD describing the research around its prevalence and prognosis. There is a consensus in the literature that there is little research and a lack of awareness of this condition. The author uses case studies from his own experience working with people with ARBD to describe the difficulties in accessing appropriate assessment and care for this group, and suggests that they are often excluded in a way that is familiar from the experience of the person with “dual diagnosis”.

Findings

– Recommendations are made including raising awareness, improving screening for cognitive impairment and developing specialist services.

Originality/value

– ARBD appears to have been neglected in the “dual diagnosis” world and this paper attempts to address this, and so should be of interest to a wide range of professionals working with substance use, mental health, homelessness and social work.