Message in a bottle opening older minds to alcohol related harm – Dr Tony Rao

Posted 08.02.2017

The intentional reference to a song from the late 1970s will strike a chord with those who have passed their half century. Yet for some, this may mean a time of increasing stress, solitude and seeking solace in the comfort of our nation’s favourite drug.

Bridging the gap

Nearly 20 years ago, when I saw referrals to my older people’s mental service for people with alcohol related mental health problems start to grow, I realised that something needed to be done to improve home-based interventions for alcohol misuse. Improving my knowledge, skills and attitudes to meet the needs of older people with alcohol misuse meant taking on a self-funded MSc as a full time NHS consultant. 12 years later, it has allowed me to bridge the gap between older people’s mental health and substance misuse to provide integrated care.

When the first alcohol information centres were set up across the UK about 50 years ago, there was a relative under-representation of older age groups, mainly owing to the high death rate from alcohol related problems in older people. 30 years later, renewed interest in the problems faced by older people with alcohol problems emerged, highlighting the need for improved detection, treatment and care. However, it was not until the early 21st century that the area began to expand, largely owing to the identification of a requirement to implement service change for this largely ‘hidden’ population, who became increasingly ‘visible’ during routine in-patient mental health encounters.

Older persons’ alcohol service

The 1990s saw the first large older persons’ alcohol service in the voluntary sector, starting in 1997 and based in Northern Ireland. Since then, 5 other services started up and were distributed in Glasgow, Birmingham, Norfolk and 4 London boroughs (Hammersmith & Fulham, Kensington and Chelsea, Bexley and Greenwich). The age limit of these services varies between 50 and 60, with all offering one to one counselling.

The past 10 years has witnessed growing expertise in the area of alcohol misuse in older people; beginning with a call to address the public health and clinical needs of this population. Faced with a rapidly growing older population experiencing alcohol misuse, one particular area of London has become one the main hubs of service development and remains the only area to have developed its own dual diagnosis strategy for older people with alcohol misuse and accompanying mental disorders. The development of a comprehensive training programme in dual diagnosis that specifically addresses the needs of older people in the local Mental Health Trust also remains unique in the regard.

In 2011, further impetus was provided through the publication of Our Invisible Addicts, the first report from the Royal College of Psychiatrists Substance Misuse Working Group. As well as collating the evidence base for the scale of alcohol misuse among older people in the UK, it highlighted the over-representation of the 55-74 age-group in alcohol related deaths and the growing rate of drinking above recommended limits in older people over the past 20 years. This report has recently been followed up by an Information Guide for health professionals and a more recent finding that 1 in 5 older people are drinking above recommended safe limits.

Drink Wise, Age Well

The Drink Wise Age Well Project now represents a giant leap forward in laying the foundation for improving awareness and education to reduce alcohol related harm in older people, as well as improving resilience and providing direct community engagement. The sheer size and distribution of the project across the United Kingdom will almost certainly lead to improvements in future interventions to reduce alcohol related harm in a growing population of older people for whom alcohol still represents a way of coping with life transitions. Achieving successful healthy ageing often involves adjusting to retirement, bereavement, chronic physical ill health and mental health problems. Drink Wise Age Well offers the hope not just of changing drinking culture in older people but improving community integration so that older people can add life to years, not just years to life.

Dr Tony Rao is a Consultant Old Age Psychiatrist working at North Southwark Community Mental Health Team for Older Adults and is also a visiting researcher at the Institute of Psychiatry, King’s College London.