We need to address drinking problems in older age
Older people struggle with alcohol problems but despite the growing demographic, there is a big gap in services catering for them
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Tony Rao
- Guardian Professional,
There is a large gap in service provision for older people with alcohol problems. Old age psychiatry services in the UK are still only able to take on older people with dual diagnosis problems; those who have both substance misuse and an accompanying mental disorder such as depression, dementia or a psychotic disorder.
In theory there is no age limit for substance misuse services, but such services are often ill-equipped to manage the particular problems faced by older people. For example, they are also not generally able to deliver a home-based service, which is very often what is needed to serve the vast majority over 65s with an alcohol problem.
The last few years have seen new developments in alcohol services in the NHS and the voluntary sector. The voluntary sector has developed considerably, with service providers emerging in areas with high rates of alcohol-related morbidity and mortality.
The most established of these is the Camden Alcohol Support Association, which offers individual counselling to older people who are concerned about their drinking. Others include Drug and Alcohol Services London, Foundation 66, Aquarius, Addaction, and the Norfolk Community Alcohol Service.
Within South London and Maudsley NHS Foundation Trust, we have developed a dual diagnosis strategy for older people, with specialist expertise and a forum soon to be set up for ‘champions’ to discuss and spread best practice.
The strategy works with representatives from the older adults service to engage with commissioners and service providers to discuss care pathways, identify accessibility issues and promote the needs of older people with dual diagnosis.
The other major part of the strategy was workforce development and training. In collaboration with the Institute of Psychiatry, the trust has developed the first five-day dual diagnosis training programme for multi-disciplinary staff across mental health older adults services. There is also now regular feedback on the quality and effectiveness of the training, as well as supervision to support the delivery of dual diagnosis interventions following the training.
It is vital to support the transfer of theory into practice and to promote further learning, and this includes a peer supervision group and a chance to reflect on any issues within clinical meetings.
Drug and alcohol screening is now mandatory for all patients being assessed and reviewed by our service, with a requirement for further screening where there is evidence of alcohol misuse. A new risk management tool has also been developed for specific use in older people.
There is firm evidence for the clinical effectiveness of interventions and between 2005-6 and 2008-09, Southwark had the second lowest increase in alcohol related admissions for people aged 65 and over among all London boroughs.
We’ve also taken advantage of mental health clusters to more widely gauge health and social outcomes for all patients in the trust.
The biggest gain for the trust has been the sustained effort to work across professional boundaries. This has been especially effective in primary care and voluntary organisations. We have delivered educational sessions to GPs, which has led to improved identification and assessment; by drawing on best practice from voluntary organisations, there is now the very real possibility of further developing new measurements, for example Outcomes Stars. There is still also scope for further joint working care agencies.
However, despite all this, there remain no addiction services dedicated to older people. With people aged 65 and over expected to form a fifth of the UK population by 2031, it’s only a start and changing attitudes towards older people who need help will no longer be an option.
Dr Tony Rao is a consultant old age psychiatrist, South London and Maudsley NHS foundation trust, and a visiting researcher at the Institute of Psychiatry in London
