Alcohol - an issue for older women too! Rolande Anderson-Project Director ICGP Helping Patients with Alcohol Problems
Main points Is any alcohol beneficial? Hidden problem; They don t run down the streets causing havoc on St. Patrick s Day!!! Greater numbers ageing and more at home drinking increase across Europe. Alerts for alcohol problems Why older women drink harmfully Beware of stereotypes What primary care can do A case history
Alcohol and the older Female Intoxicated quicker Drunkenness less socially acceptable More physical problems More difficult to detect more likely to be secretive vague symptoms N.B. Psycho-somatic complaints Less family support
Alcohol and the older Female 2 Greater guilt and shame Deep resentment (the F.U. Syndrome!?) More life events Die younger (without treatment) Increased risk of cross-addiction Different in treatment and post treatment issues Remember ; there is a great deal of ignorance re basic alcohol information (e.g.) gender differences/tolerance, among patients - important role for primary care staff
Man takes a drink, Drink takes a drink, Drink takes the man (Alcoholics Anonymous) It takes the woman too!
Most Important BEWARE; Stereotypes and Labels Attitudes/prejudices
Why are older women dependent on alcohol? Because they are dependent on alcohol!
Why do Older women problem drink? Anger, pleasure, relaxation, anxiety, depression, fear, physical, mental illness, avoidance Body changes, loss, loss of roles (empty nest), isolation, Frustration, stress, the F.U. syndrome Social contacts, to block emotions, to forget Men!, violence, sexual abuse, relationship problems Reduced Inhibitions social and sexual And loads more besides!!
What sorts of problems? Practical problems Finances Bills Debt Poor Diet and Hygiene Emotional distress Fear, Shame, Anger, Failure, Loneliness Panic, Worn-out, Poor self esteem, Sleeping problems Worries re children Psychiatric issues Depression Anxiety Phobias Dementia Relationship problems Marital/Relationship issues Grandchildren Physical problems
Alerts for hazardous, harmful drinking and alcohol dependence Related to Intoxication Trauma accidents, falls Gastritis: haematemesis Cardiac arrhythmia Acute pancreatitis Acute hepatitis Acute alcohol poisoning Failure to take prescribed medication properly Suicidal behaviour SOCIAL: marital disharmony ; shoplifting; road traffic offences; children disturbed. PSYCHIATRIC: anxiety disorders, including panic disorder, depression; hallucinosis; paranoia; jealousy; delirium. Related to regular heavy drinking Fatty liver; cirrhosis Peripheral neuropathy; cerebellar ataxia Cardiomyopathy Hypertension; haemorrhagic stroke Psoriasis Osteoporosis Brain damage: Wernicke-Korsakov syndrome; dementia Cancer (mouth, larynx, oesophagus, breast, colon) Chronic pancreatitis Bone marrow depression: low platelet count Neutropaenia Withdrawal seizure incontinence Tired all the time
Say Hello to Mary! 82, first met her when she aged 55 Alcohol dependence since age 35? Blind in one eye, loads of medication Husband died 3 years ago Lonely ++, depressed Dementia??, drinks x2 bottles per day when drinking Still plays golf regularly Not allowed to baby-sit, falls regularly, no dignity when drinking 2-3 bottles of wine per day during binge Terrified of Residential treatment AA
Barriers to getting help? Internal Denial and ignorance Fear of stigma Fear of label and of admission External No time in General Practice Lack of training Doctors own attitudes and prejudices
What can be done? 1. Ask DON T PATRONISE OR BULLY Just ask Open ended questions Impact on family Motivational Interviewing Brief Intervention 3. Assist Support, encourage and advise Check out practical problems Give out Leaflets and Book titles Present options and tips Treat presenting problem 2. Assess? Alcohol problem life-time drinking, medication interactions? Psychiatric problem Use Audit Check notes 4. Arrange Review date To see his/her family Patience!
MEN WOMEN 50 Standard Drinks Per week 35 Standard Drinks Per week Alcohol Consumption and the Risk of Physical Harm Weekly Guideline 21 Standard Drinks Per week 14 Standard Drinks Per week
Relationship Between Alcohol Use and Alcohol Problems None ALCOHOL USE Light Moderate Heavy Low Risk At Risk Problem Dependent Moderate Severe None Small ALCOHOL PROBLEMS
Self Help A.N.E.W. Able and New Women 2000 to date A.A. Women only