Alcohol problems often go unrecognised in older people, a leading GP has warned.
According to Dr Juliet Bressan, a GP specialising in substance misuse with the HSE Addiction Service in north Dublin, alcohol consumption in Irish people over the age of 65 tends to be lower than that of other age groups.
However 10% of this population consume alcohol on more than four days per week ‘therefore while older people may consume less alcohol in volume per capita, their pattern of drinking is risky'.
She pointed out that binge drinking and the frequency of consumption are a particular problem in older people ‘due to the increased vulnerability of age'.
However, alcohol problems can remain unrecognised in older people because of a number of reasons, including a lack of training or awareness among healthcare professionals and inappropriate screening tools. In fact, a lack of appropriate screening tools and a failure to implement screening tools in this age group ‘has been identified as a major barrier to identification', Dr Bressan noted.
She said that many screening tools were developed in the US and do not apply here. One screening tool that is often used by GPs here - the CAGE questionnaire which is made up of four questions - can identify dependent drinkers, however ‘it does not necessarily identify risky social drinking which is very acceptable in countries like Ireland'.
Meanwhile Dr Bressan also pointed out that alcohol use in older people can lead to serious health issues such as acute gastric bleeding, heart disease, stroke and certain cancers. If a patient presents with these problems, it is often these that are treated, while the underlying alcohol problem is missed.
"Alcohol disorder typically presents in older people as falls, dementia, cardiac problems, hypertension, insomnia, confusion, depression or self-neglect," she noted.
Dr Bressan also said that societal myths ‘can lead relatives to believe that regular alcohol consumption is tolerable or to be encouraged socially in older people'.
She pointed out that national policies and prevention strategies often focus on reducing alcohol consumption in younger people. For example, while the 2012 Steering Group Report on a National Substance Misuse Strategy recommends research on different groups, including older people, ‘there are no specific actions aimed at the challenges associated with alcohol misuse in the over 65s'.
Dr Bressan called for more awareness and training among healthcare professionals about this issue.
"Older people are as likely as young people to benefit from screening, brief intervention and treatment for alcohol use disorder, therefore increasing training and awareness among health professionals and advocacy for senior health should be a priority to address the risks of alcohol consumption in this vulnerable population," she added.
Dr Bressan made her comments in Forum: Clinical Challenge. Forum is the journal of the Irish College of General Practitioners.
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