reducing alcohol-related harm in older people: a public health approach sarah waddmarch 2014
TRANSCRIPT
Reducing Alcohol-Related Harm in Older People: A Public Health Approach
Sarah Wadd March 2014
Public Health Approach to Prevention
Surveillance: What is the problem?
Identify risk and protective factors:
What are the causes?
Develop and evaluation interventions:
What works and for whom?
Implementation:Scaling up effective
policy and programmes
What is the extent of the problem?
• 1.4 million older people exceed drink limits.
• More than half a million alcohol related hospital admissions each year.
• More likely to be admitted to hospital or die from alcohol-related problem.
• Levels of harm increasing fastest in this age group.
• Drink driving prosecutions increasing.
The time to act is now
What is alcohol prevention?
• Preventing new alcohol problems developing.• Providing interventions and
treatment for hazardous, harmful and dependent drinkers.• Reducing harm in people unable or
unwilling to reduce/stop drinking.
Is it worth it?• 1 in 3 alcohol problems in older people
develop in later life.• Many alcohol-related harms are reversible.• Older people more likely to be treated
successfully.• Even those with long history of misuse can
change.• Prevention much cheaper than dealing with
consequences alcohol-related harm.
National Policy• Regulating physical availability• Taxation and pricing• Drink driving• Treatment and early intervention• Controlling the promotion of alcohol• Education and persuasion
Why do Older People Require Special Consideration?
• Have unique vulnerabilities.
Vulnerability to Alcohol-Related Harm
Muscle is replaced by body fat as people age. Alcohol is not drawn into body fat as well as it draws into muscle, therefore, blood alcohol concentration is higher in older people
Activity of the enzyme alcohol dehydrogenase, which breaks down alcohol is significantly reduced. There is decreased blood flow to the liver
Alcohol produces a more rapid depressant effect on brain and older people are particularly sensitive to the toxic effects of alcohol on the brain
Older people are more susceptible to imbalance after acute alcohol ingestion making them susceptible to falls. More likely to be experience a fracture if they fall.
Why do Older People Require Special Consideration?
• Have unique vulnerabilities.• Drink in different ways.• Have different risks and
protective factors.
Risk and Protective Factors
ReR IndividualRelationshipsWorkCommunity/EnvironmentSociety
• Personal attitudes• Knowledge• Coping skills/resilience• Chronic pain, insomnia• Time & opportunity to drink• Disability• Mental health• Cognitive impairment• Financial circumstances
• Bereavement• Loss of friends• Family conflict/relationship breakdown• Being carer• Family attitudes towards drinking• Elder abuse
• Retirement• Unemployment• Occupational socialisation• Drinking culture
• Activities for older people• Transport• Sense of safety• Community norms • Availability of alcohol• Health and social services• Alcohol services• Residential care• Deprivation
• Attitudes towards older people• Social capital• Societal attitudes towards alcohol
Wadd, 2014
Risk and Protective Factors
ReR IndividualRelationshipsWorkCommunity/EnvironmentSociety
• Personal attitudes• Knowledge• Coping skills/resilience• Chronic pain, insomnia• Time & opportunity to drink• Disability• Mental health• Cognitive impairment• Financial circumstances
• Bereavement• Loss of friends• Family conflict/relationship breakdown• Being carer• Family attitudes towards drinking• Elder abuse
• Retirement• Unemployment• Occupational socialisation• Drinking culture
• Activities for older people• Transport• Sense of safety• Community norms • Availability of alcohol• Health and social services• Alcohol services• Residential care • Deprivation
• Attitudes towards older people• Social capital• Societal attitudes towards alcohol
Why do Older People Require Special Consideration?
• Have unique vulnerabilities.• Drink in different ways.• Have different risks and
protective factors.• Have different attitudes,
values and beliefs.
“I just like the one-to-one [therapy]. I am very afraid of going into a crowd [group therapy].…..I think because it
is a personal problem there is a terrible shame about it....I’m not
having to share the shame with lots of people. It is terrible, terrible
shame.”
(Wendy, 73, early-onset)
Why do Older People Require Special Consideration?
• Have unique vulnerabilities.• Drink in different ways.• Have different risks and
protective factors.• Have different attitudes,
values and beliefs.• Have different levels of
knowledge
Percentage of Respondents who had heard of Alcohol Units
1997 1998 2000 2002 2004 2006 2007 20080
10
20
30
40
50
60
70
80
90
100
56
76
16-2425-4445-6465 and overPe
rcen
tage
s
Source: Omnibus Survey, 1997-2008
Why do Older People Require Special Consideration?
• Have unique vulnerabilities.• Drink in different ways.• Have different risks and
protective factors.• Have different attitudes,
values and beliefs.• Have different levels of
knowledge• Face different barriers.
Professional Barriers• Lack of awareness that alcohol misuse is a potentially
important problem for older people.• Reluctance to ask embarrassing questions of older
people.• Attitude that older people are too old to change their
behaviour.• Belief that it is wrong to ‘deprive’ older people of
their ‘last pleasure in life’.• Inability to identify signs and symptoms of alcohol
problems in older people.
Why do Older People Require Special Consideration?
• Have unique vulnerabilities.• Drink in different ways.• Have different risks and
protective factors.• Have different attitudes, values
and beliefs.• Have different levels of
knowledge• Face different barriers.• Have different motivatiors.
Motivators for Older People
• Staying healthy and independent.
• Sleeping better.• More energy to go out
and socialise.• Improved memory.• Save money.• Less likely to fall.
Preventing New Alcohol Problems
• Increasing understanding of alcohol units.
• Improving coping skills in carers.
• Providing bereavement counselling.
• Providing activities and opportunities to socialise.
Providing Age-Appropriate Interventions and Treatment
• Advice on alcohol and medication interactions.
• Brief interventions which focus on motivating factors for older people.
• Alcohol services which are culturally appropriate for older people.
• Alcohol treatment at home.
Harm Reduction• Address trip and fire
hazards.• Ensure they are eating
properly.• Assess risk of elder abuse.• Consider thiamine therapy
for heavy drinkers.
