Assessing the mental health needs of older people
Drug and alcohol problems
Not a great deal is known about the incidence of alcoholism and substance misuse in older people, including misuse of over-the-counter medication. It is often assumed that older people are not affected to any great degree by these issues, but it is more likely that the incidence is hidden. While it appears to be true that alcohol use and misuse declines with age, the use of prescription and over-the-counter drugs increases in later life. Substance use and misuse is probably the area of older people's mental health that is least researched or written about, although it may sometimes be a significant factor in assessment. Changes in attitude in younger generations mean that alcohol consumption amongst older people, and possibly use of illicit drugs, is likely to increase as these groups age.
While older people generally drink less than younger people, physical changes in later life mean that older people are more likely to be adversely affected by alcohol at lower levels of consumption:
- Alcohol consumption has been identified as one of the three most common reasons for falls in older people.
- Alcohol can react adversely with medication, and can precipitate acute confusional state.
- Alcohol may also contribute to cognitive impairment in dementia.
- Alcohol problems can significantly impair the health and quality of life of older people:
- Excessive drinking puts older people at increased risk of coronary heart disease, hypertension and stroke.
- Alcohol can increase the likelihood of incontinence and gastrointestinal problems; heavy drinking can lead to self neglect, poor nutrition, poor hygiene and hypothermia.
In addition, long-term alcohol misuse can lead to Wernicke-Korsakoff syndrome, which is a form of brain damage characterised by memory loss. The effects can include:
- poor attention
- self-centred and withdrawn behaviour
- difficulties with problem solving and learning new information
- impairment of short- and long-term memory.
Alcohol misuse often goes undetected because the symptoms, such as accidents, malnutrition, self-neglect, depression, insomnia, and confusion, can be non-specific and hard to distinguish from other causes. On assessment, older people may under-report their level of alcohol use, because of the stigma attached, or because they regard alcoholic drinks as medicinal, alleviating other health problems. Family members, health professionals and care staff may ignore problems on the basis that alcohol is 'one of the few pleasures left' to an older person.
Older people are also at risk of over-medication, of both prescribed and over-the-counter drugs, particularly sedatives, hypnotics and tranquillisers. Older people may self-medicate, for instance for insomnia or other problems, but over-medication, or interactions with alcohol or between drugs, may exacerbate their problems.
- Alcohol misuse has potentially severe social and health consequences in later life.
- The number of older people with alcohol problems is likely to increase.
For more information on drug and alcohol problems in older people, see:
Alcohol Concern' factsheet: Alcohol and Older People
Derry, A.D. (2000) 'Substance use in older adults: A review of current assessment, treatment and service provision', Journal of Substance Use vol. 5, pp 252-262.
Herring, R. and Thom, B. (1997) 'Alcohol misuse in older people: the role of home carers', Health and Social Care in the Community vol. 5 (4) pp 237-245.
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