Assessing the mental health needs of older people
Herring R & Thom B (1997) Alcohol misuse in older people: the role of home carers Health and Social Care in the Community 5 (4) pp.237-245
The extent to which older people drink harmfully is unclear and research is scant and contradictory. Although older people generally drink less than younger people, it is estimated that in the UK 17% of men and 7% of women over 65 drink above the recommended limits.
Research has been concerned with excessive drinking rather than examining contexts and circumstances within which alcohol may increase the risk of harm for older people. Alcohol consumption has been identified as one of the three most common reasons for falls in frail older people.
Problems and detection
Depression in older people brought on by bereavement and life changes may involve alcohol use. Alcohol can adversely react with medication, particularly anti-depressants. Alcohol can precipitate acute confusional states which may be attributed to a number of other causes. There is some evidence to suggest that alcohol can contribute to cognitive impairment in dementia.
Detection of alcohol misuse in older people is challenging. Although classical presentation does occur older people can present in non-specific ways such as falls, malnutrition, self-neglect and confusional states. It is sometimes difficult to distinguish some of these symptoms from those of the ageing process.
Community care roles and responsibilities
As alcohol use is associated with a range of social and medical problems experienced by older people, domiciliary workers are likely to encounter problem drinking among their clients.
One research study suggested that although the majority of community carers felt confident enough to broach the topic of problem drinking, they were uncertain about sources of support for older drinkers and lacked the necessary knowledge for the detection of alcohol misuse. Many held negative beliefs about substance use and were unsure of their responsibilities.
Structural barriers within community care, particularly those between health and social care, have also impeded detection. Community care has positioned home carers as central to the care of older people, but home care workers have expressed concern that they are undertaking 'nurse's work' (i.e. intimate personal and emotional care). The locus of responsibility for an appropriate response to alcohol misuse in older people is therefore unclear.
The following points give some possible solutions to the difficulties surrounding prevention and intervention:
- Further research about circumstances associated with problem drinking in older people, risk of harm and the relationship of mental health and alcohol misuse in older people needs to be undertaken.
- Alcohol awareness training for all social care staff, particularly home care workers is needed. This should focus on problems specific to older clients and incorporate a more positive approach to ageing and health.
- A comprehensive response strategy, which includes home carers, social workers and GPs, needs to be negotiated between health and social services. The possibility of alcohol misuse needs to become part of the assessment of older people.
- A comprehensive, inter-agency policy is required to clarify the roles and responsibilities of various agencies and workers.
- The role of home care worker needs clear definition, including the limits of that role. The part home carers can play in the detection of and response to alcohol misuse in older people depends on the level of 'professionalisation' of the home care role.