NORCAS – alcohol.drugs.gambling change happens together

1. NORCAS – alcohol.drugs.gamblingchange happens together

2. NORCAS - OVER 50s OUTREACH SERVICE THE RESEARCH – BACKGROUND • Obtaining reliable information about drinking behaviour in older people is difficult. • This often because people consciously or unconsciously under-estimate how much alcohol they consume. • Drinking at home is particularly likely to be under-estimated because the quantities consumed are not measured and are likely to be larger than those dispensed in licensed premises.

3. NORCAS - OVER 50s OUTREACH SERVICE THE RESEARCH – YOUGOV(2009) • More than 1 in 8 over-60’s drink more after retiring. • Of these – • 19% use alcohol because of depression • 13% drink to deal with bereavement • 1 in eight most often drink alone, at home. • Pensioners accounted for 357,300 alcohol-related hospital admissions in England (2007-08), a 75% rise in 5 years.

4. NORCAS - OVER 50s OUTREACH SERVICE THE RESEARCH – U.W.E.(2009) • “The degree to which the issue of alcohol in relation to older people is under-researched in the UK is remarkable.” • “In the next few years alcohol-related problems amongst older people are likely to exert greater pressure on health and other social services.” • “Links with specialist agencies need to be established and if local alcohol services are inadequate steps should be taken to create effective provision.”

5. NORCAS - OVER 50s OUTREACH SERVICE HEALTH GUIDELINES • Maintaining good health is a critical issue for older people. • Nationally, 8% of patients aged 65 and over who are admitted to hospital are abusers of alcohol. • People aged over 65 are some of the heaviest users of health services, with the NHS spending around 40% of its annual budget on this age group.

6. NORCAS - OVER 50s OUTREACH SERVICE ALCOHOL UNITS • NHS advice on drinking recommends that men should not regularly drink more than 3–4 units of alcohol a day and women should not regularly drink more than 2–3 units a day. • ‘Regularly’ means drinking every day or most days of the week. • It’s more appropriate to set benchmarks for daily than for weekly consumption of alcohol, because of risks associated with single episodes of intoxication.

7. NORCAS - OVER 50s OUTREACH SERVICE ALCOHOL UNITS • The alcohol content of a drink is measured in units. • One unit is 10ml (or approximately 8 grams) of ethanol. • This is approximately the amount of ethanol an average healthy adult can break down in an hour. • You can calculate the units in a drink by multiplying the amount in millilitres (ml) by the strength (ABV) and dividing the result by 1000.

8. NORCAS - OVER 50s OUTREACH SERVICE ALCOHOL UNITS http://units.nhs.uk/unitCalculator.html

9. NORCAS - OVER 50s OUTREACH SERVICE WHY ARE OVER 50s MORE VULNERABLE? • Physiological changes that occur as part of the ageing process mean that older people are more vulnerable to alcohol and experience problems at lower levels of consumption. • As people age their ratio of water to fat changes. • Having less water leads to higher blood alcohol levels from smaller amounts of alcohol. • As the cardiovascular system, central nervous system, liver and kidneys etc age their capacity to tolerate the toxic effects of alcohol reduce.

10. NORCAS - OVER 50s OUTREACH SERVICE WHY DO OLDER PEOPLE DRINK? • Change of lifestyle • retirement • decreased social activity • Isolation and loneliness • Coming to terms with illness and ill health • Alcohol as an anaesthetic - this may also be seen as a way of justifying the drinking.

11. NORCAS - OVER 50s OUTREACH SERVICE WHY DO OLDER PEOPLE DRINK? • To aid sleep • especially if they are experiencing some sort of physical or emotional distress. • However, although alcohol in small quantities may aid sleep, in larger quantities it can itself cause disturbed sleep patterns and wakefulness during the night.

12. NORCAS - OVER 50s OUTREACH SERVICE RISK FACTORS OF DRINKING IN OVER 50s • As people move into older age brackets, their tolerance for alcohol tends to decrease. • This is because when alcohol is absorbed, it is distributed throughout the body’s total water content, but the volume of total body water decreases with age, so a given amount of alcohol produces a higher blood alcohol concentration [BAC]. • Coupled with this, there may be a reduced capacity for the nervous system to tolerate alcohol.

13. NORCAS - OVER 50s OUTREACH SERVICE RISK FACTORS OF DRINKING IN OVER 50s • Older people often take regular medication, which may interact with alcohol to cause unpleasant or dangerous side effects. The risk is considerably greater when a number of medications are involved. • Falls are an increasing risk with advancing age, and this risk is also increased by intoxication, with potentially serious and disabling consequences.

14. NORCAS - OVER 50s OUTREACH SERVICE RISK FACTORS OF DRINKING IN OVER 50s • Driving may be influenced by the effects of ageing, particularly visual loss and slowed reaction time. • Again, any risk in this area can be increased by alcohol, and by the increase in BAC, with the potential to affect others as well as the driver.

15. NORCAS - OVER 50s OUTREACH SERVICE EXCESSIVE ALCOHOL- • Can put older people at increased risk of Coronary Heart Disease, hypertension and stroke. • May add to the risk of falls and accidents and has been identified as one of the three main causes of falls in older people • Will exacerbate insomnia • Is likely to increase the incidence of incontinence and gastrointestinal problems such as stomach ulcers

16. NORCAS - OVER 50s OUTREACH SERVICE EXCESSIVE ALCOHOL- • Can worsen memory loss and depression • Is linked to research that proves its contribution to dementia – 10% of elderly people presenting with dementia have alcohol-related brain damage • Has been implicated in a whole set of problems relating to self-neglect including poor nutrition, poor hygiene, hypothermia

17. NORCAS - OVER 50s OUTREACH SERVICE EXCESSIVE ALCOHOL- • Is linked with psychiatric problems such as depression, anxiety and increased phobias in old age. Alcohol is a factor in one in three elderly suicides

18. NORCAS - OVER 50s OUTREACH SERVICE AWARENESS OF MISDIAGNOSIS • Alcohol problems can go undetected for longer among older people. • Older people tend not to have regular employment and often have reduced social interaction. • Those that do interact with the drinker may ignore or fail to identify problems.

19. NORCAS - OVER 50s OUTREACH SERVICE AWARENESS OF MISDIAGNOSIS • Alcohol misuse can present in a number of non-specific ways many of which are linked to the aging process • accidents • depression • insomnia • confused states • self-neglect

20. NORCAS - OVER 50s OUTREACH SERVICE EXAMPLE 1 • Ethel Oldlady is 72yrs lives alone in her ground floor flat. Other than complaining of earache she is usually fit, well and fiercely independent. • You visit every afternoon and lately have noticed that she - • Smells of alcohol • Rarely finishes her lunch • Unsteady on feet • Sleepy • Slurring speech

21. NORCAS - OVER 50s OUTREACH SERVICE ACTUALLY... • She only drinks one small sherry with her lunch each day. • Symptoms of middle ear infection include nausea and an altered sense of balance. • Most doctors treat these infections with a drug called prochlorperazine which, if taken with alcohol, often causes drowsiness and a difficulty in speaking clearly.

22. NORCAS - OVER 50s OUTREACH SERVICE EXAMPLE 2 • Arthur Agingchap is a 59 yr old retired army captain who has always lived alone and is usually very friendly and chatty. You visit once a week to collect his lottery syndicate money. • Today he is sitting in a chair and seems agitated and confused. He has an empty bottle of whiskey on the floor next to him and smells strongly of alcohol. You notice that he has been incontinent and seems to be behaving in an aggressive way towards you.

23. NORCAS - OVER 50s OUTREACH SERVICE ACTUALLY... • This is the true story of a man who had been institutionalized because of those symptoms. • Initially diagnosed as having had a "nervous breakdown" due to his “alcoholic past”. • Later discovered that he had a stroke complicated with dysphasia (inability to communicate thoughts). • During this episode he had dropped the whiskey bottle, from which he had been pouring his usual evening tot, spilling it on himself. Hence the “smell of alcohol”.

24. NORCAS - OVER 50s OUTREACH SERVICE ALCOHOL AND MEDICATION • In the UK, people over 65 represent 18% of the population but receive 45% of prescribed medications • The most commonly prescribed drugs for older people are – • Antihypertensives – blood pressure • Treatments for respiratory disease • Antidepressants, • Anticoagulants – blood clotting • Antidiabetics • Analgesics – pain killers

25. NORCAS - OVER 50s OUTREACH SERVICE ALCOHOL AND MEDICATION • These interactions may increase the effect of a medicine (e.g. the sedative effect of an hypnotic), exacerbate a side effect (e.g. the drowsiness associated with use), or result in a new syndrome (e.g. the unpleasant effects of combining alcohol and some antibiotics). • Nearly half of over 65s are taking five or more drugs, • Studies indicate that more than half of those taking prescribed medications also drink alcohol.

26. NORCAS - OVER 50s OUTREACH SERVICE ILLEGAL SUBSTANCES USE IN OVER 50s • Continues to be perceived as behaviour of young people • There are currently no UK statistics available on illicit drug use among older people – even British Crime Survey data stops at age 59! • The baby boomer generation came of age in the 1960s, a time when many young people experimented with illegal drug use. • Research from USA shows 1 in 3 over 50s abuse prescription drugs such as painkillers and sleeping pills.

27. NORCAS - OVER 50s OUTREACH SERVICE RAISING THE ISSUE • People with alcohol problems often have a low opinion of themselves. • You can’t stop people from drinking, but you can help them to feel better about themselves. By treating them with respect, you can help them to find the self-respect and strength they need to deal with their alcohol problems. • Don’t use terms like “alcoholic” or “addict.”

28. NORCAS - OVER 50s OUTREACH SERVICE RAISING THE ISSUE • If you confront the person about his or her problem alcohol use (e.g. “You’ve got a problem” or “You should stop drinking”) the person will likely deny having a problem, and will refuse to talk about it. • When talking with older people with alcohol problems, put “the person” before “the problem.” • Encourage the person to talk about his or her drinking when the person is sober (e.g., “What did you do last night?” “How are you feeling this morning?”).

29. NORCAS - OVER 50s OUTREACH SERVICE RAISING THE ISSUE • Describe what you see (e.g., “I’ve noticed you’ve been having difficulty walking.” “As far as I can tell, you’ve eaten only biscuits this week. Is there a problem with your meals?”). • Avoid saying that the person’s problems will go away if they stop drinking. • Try saying, “You don’t seem to be your old self these days. How are you feeling? Would you be interested in having someone to talk to about it?”

30. NORCAS - OVER 50s OUTREACH SERVICE HARM REDUCTION • If you are worried about yourself or someone else there are things you can do to reduce the harm: • talk to a professional about your concerns • always eat before you drink, alternate alcoholic drinks with soft drinks and don’t mix different types of alcohol • be aware of the facts about alcohol • never tell a long term drinker to just stop drinking - alcohol is a physically addictive substance and sudden withdrawal can be fatal

31. NORCAS - OVER 50s OUTREACH SERVICE THE PROJECT • Funded for 4 years by The Big Lottery Reaching Communities programme which aims to – • improve the lives of people and communities in need across England. • fund projects that respond to needs identified by local communities and actively involve them. • support initiatives that help those most in need, including people and groups who are hard to reach.

32. NORCAS - OVER 50s OUTREACH SERVICE PROJECT AIMS • To improve the health and the lives of people over 50 who are affected by their own substance misuse or that of a relative or friend. • To support people who are carers or concerned for someone over 50. • To work with and relieve pressure on professionals and other agency staff who represent this age group.

33. NORCAS - OVER 50s OUTREACH SERVICE PROJECT AIMS • To decrease social isolation and increase community participation. • For our counsellors and substance misuse worker to provide an innovative and professional support alliance, which will include therapy, assistance and motivation, signposting and advice.

34. NORCAS - OVER 50s OUTREACH SERVICE THE TEAM • Julia Wildin - Counsellor andcontact for North Norfolk • 07903688736 – j.wildin@norcas.org.uk • David Warner – Counsellor and contact for South Norfolk • 07951591645 – d.warner@norcas.org.uk • Simon Wakefield – Substance Misuse Worker and contact for Central Norfolk • 07903688947 – s.wakefield@norcas.org.uk

35. NORCAS - OVER 50s OUTREACH SERVICE INTERVENTIONS OFFERED • Brief interventions • Education – including staff • Group work • Psychosocial interventions • Referral to clinical services and others • Also access to all other NORCAS services – abstinence groups, acupuncture etc

36. NORCAS - OVER 50s OUTREACH SERVICE STAFF EDUCATION • Our training and education service can help organisations and their staff to develop their knowledge and enhance good practice in all aspects of alcohol and drug issues for the over 50s age group. • Our Training and Consultancy department is available to deliver bespoke training sessions.

37. NORCAS - OVER 50s OUTREACH SERVICE REFERRAL • If you are concerned about your or someone else’s use of alcohol or drugs and you’d like more information about the Over 50s Outreach Service, help or advice, please get in touch with us.

38. NORCAS – OVER 50s OUTREACH SERVICE Contact e-mail over50s@norcas.org.uk Phone 01603 660070 Fax 01603 629837 Self Referral Written Referral NORCAS 35-37 Exchange St, Norwich NR2 1DP

39. NORCAS – alcohol.drugs.gamblingchange happens together