Alcohol Disorders in Older Adults: Common but Unrecognised. Amanda Quealy Chief Executive Officer The Hobart Clinic Association

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1 Alcohol Disorders in Older Adults: Common but Unrecognised Amanda Quealy Chief Executive Officer The Hobart Clinic Association

2 The Hobart Clinic Association Not-for-profit private Mental Health Service founded 30 years ago. Major depression, treatment resistant depression, anxiety, alcohol and drug addictions, borderline personality disorder, aged psychiatry, Tas Memory Clinic Eastern shore The Hobart Clinic, 27 bed hospital (assessment, treatment, detox), day therapy programs and medical consulting suite. City Centre Murray Street Clinic, therapy groups, medical consulting suite. In 2013, specialist 8 bed unit, aged friendly rooms, separate dining/lounge and activity area for people over 65 with mental health and/or addiction problems. The Hobart Clinic Association

3 How significant are the demographics? Tasmania has 17.3 % of its population over 65 years which equates to 89,000 people. ( ABS, Dec 2013) Projected to be 18% by 2020 and 2040 when Tasmania s population is projected to be 570,000 we will have 131,100 over 65 years (23%) We are the oldest State with a median age of 41.2 years (national average is 37 years) By 2040 nationally there will be 6.8 million people over 65 years! The Hobart Clinic Association

4 Underlying assumptions in analysing alcohol related disorders in older people As the number of people over 65 increases, issues to do with alcohol dependency become substantially more significant. That older people are just as likely to benefit from treatment as younger people. That the current alcohol treatment, rehabilitation and the community sector services as well as the aged care system are not equipped to respond. Primary health sector refers less older people for mental health treatment and psychological services than younger people. The Hobart Clinic Association

5 Patterns of alcohol abuse in the aged Early - onset, where the person has had a lifelong pattern of problem drinking Likely to be a strong family history, more likely to have mental health issues (depression, anxiety, personality disorder), physical health issues (cirrhosis and other physical health conditions) and alcohol dementia. (Estimated to be about 2/3 of older people with alcohol dependency) Late onset, drinking commenced years of age. More highly educated, stressful lifestyles, usually fewer physical and mental health problems. The Hobart Clinic Association

6 Profile of heavy drinking on older age Gender males twice as likely to drink excessively, in particular older single men. Socio-economic status equal in terms of gender, most prevalent in the higher social class Those who feel socially excluded White Anglo-Saxon greater consumption at higher risk levels than other ethnic backgrounds (such as Asian, African or Muslim) Genetic factors, seem more significant in early onset in particular for males. The Hobart Clinic Association

7 Factors that impact upon the likelihood of alcohol abuse in old age Bereavement, loss of friends, loss of occupation Social isolation Impaired ability to function Family conflict Reduced self esteem Physical disabilities, chronic pain, insomnia, hearing and eyesight deterioration Cognitive impairment, impaired self care, reduced coping skills, financial hardship The Hobart Clinic Association

8 What are the health risks of alcohol abuse in older age? Higher rates of depression in older people with an alcohol dependency Increased risk of stroke Decreased bone density Gastrointestinal bleeding Malnutrition Disturbed sleep Confusion and cognitive impairment is made worse Negative interaction with prescribed drugs, 8 out of 10 people over 65 years reporting to mix both. Higher rates of suicide (particularly men over 75 years) The Hobart Clinic Association

9 Would you recognise an older person at risk? The Hobart Clinic Association

10 Risk of suicide in older adults Tasmania has 2 nd highest rate in Australia WHO (2001) reported that older people have much higher rates of suicide than the general population, with greater completion rates. Males 65 years +, 3-4 times more likely to suicide. High risk factors: depression, physical illness, social isolation, significant grief and loss Link between intoxication and suicide at the time of death GP s recognise suicidal risk, but are less likely/willing to optimise therapeutic strategies. Any older person who attempts suicide MUST be taken seriously The Hobart Clinic Association

11 The Risk is Real The Hobart Clinic Association

12 National Ageing Research Institute (NARI) Depression in Older Age Study 2009 Significant barriers to treatment for older people Stigma associated with not coping, weakness Non reporting to GP s Ageism- negative attitudes towards older people, treating them differently, particularly in a medical setting, less referrals by GP s to mental health services. Lack of professionals in all disciplines specialising in mental health in old age The Hobart Clinic Association

13 NARI findings GP s were first point of contact Therapy/counselling helpful Medication Exercise Social Programs More research is required and a focus on prevention Should be a health priority in particular with an ageing population Raising community awareness The Hobart Clinic Association

14 Bio-Psycho-Social Approach Medical Detox in a supported environment Antidepressants 60% efficacy Can take up to 6 weeks to see the benefits ECT a safe option for the aged, transient cognitive impairment, effective for severe depression and where medication has had a poor response. Psychological interventions to deal with: Managing cravings and stressful situations Grief and loss Early stage dementia Loss of sense of self Suicidal ideation Fear of the unknown and anxious Resentment and Anger The Hobart Clinic Association

15 Social and Community interventions Community and government recognition of the size and significance of the problem. Health promotion to highlight, prevalence and health consequences Specialist training in the aged care sector, local government and primary health care sector How does the Alcohol and Drug community services sector respond? The Hobart Clinic Association

16 References: Discussion Paper (2011) Older Tasmanians Mental Health and Wellbeing Forum (MHCT, COTA Tas) Dr Karim Dar (2014) Alcohol use disorders in elderly people: fact or fiction? Australian Bureau of Statistics, Dec 2013 National Ageing Research Institute (2009) Depression in Older Age Study The Hobart Clinic Association

17 Contact details Amanda Quealy The Hobart Clinic Tel: Web: The Hobart Clinic Association

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