Risky drinking and dual diagnosis in older people under a UK community old age psychiatry service

2019 ◽  
Vol 12 (4) ◽  
pp. 200-208
Author(s):  
Rahul Rao
Keyword(s):  
Cognitive Impairment ◽  
Alcohol Use ◽  
Older People ◽  
Binge Drinking ◽  
Dual Diagnosis ◽  
Community Services ◽  
Risky Drinking ◽  
Cognitive Screening ◽  
Loss Of Function ◽  
Content Type

Purpose The assessment of patterns in risky drinking and its association with dual diagnosis in community services for older people remains under-explored. The paper aims to discuss this issue. Design/methodology/approach Drinking risk using the Alcohol Use Disorders Identification Test (AUDIT) and the presence of co-existing mental disorders was examined in 190 people aged 65 and over. Findings In total, 24 per cent of drinkers drank above lower risk levels and 22 per cent reported binge drinking over the past 12 months. Those scoring 1 or more on the AUDIT were more likely to be male and to have greater cognitive impairment than non-drinkers and those reporting no past problems with alcohol. Research limitations/implications Given the limitations of the Mini Mental State Examination in the detection of alcohol related cognitive impairment (ARCI), the use of other cognitive screening instruments in larger study populations is also warranted. Practical implications Greater attention needs to be paid to the assessment of risky drinking in older male drinkers and those with cognitive impairment. Originality/value There is considerable scope for the routine detection of cognitive impairment and dementia in older people with alcohol use within mainstream mental health services, particularly in those with binge drinking. As ARCI is associated with loss of function and independence, early detection and intervention can improve health and social outcomes.

scholarly journals Prevalence of cognitive impairment among hill-tribe older people in the Northern part of Thailand

2018 ◽  
Vol 32 (6) ◽  
pp. 478-484
Author(s):  
Supaporn Trongsakul ◽  
Thapakorn Ruanjai ◽  
Wilawan Chaiut ◽  
Ratipark Tamornpark ◽  
Tawatchai Apidechkul
Keyword(s):  
Cognitive Impairment ◽  
Older People ◽  
Cognitive Decline ◽  
Health Care Professionals ◽  
Cultural Bias ◽  
Cognitive Screening ◽  
Content Type ◽  
Hill Tribe ◽  
History Of ◽  
Amphetamine Use

Purpose The purpose of this paper is to investigate the prevalence and factors related to cognitive impairment among hill-tribe older people in Chiang Rai province, Thailand. Design/methodology/approach A cross-sectional study was carried out amongst 459 hill-tribe older people aged 60 years and above. A Mini Mental State Examination (MMSE) Thai 2002 version was used for cognitive screening. A questionnaire and medical records were used for demographic and clinical data collection while descriptive statistics were used to analyze characteristic data. Potential factors related to cognitive impairment were analyzed by using univariate logistic regression analysis. Findings The prevalence of cognitive impairment amongst the participants was 49.89 percent (95% CI 45.32%, 53.47 percent). Factors related to cognitive decline included no occupation (OR=1.49, 95% CI 1.10–2.03, p<0.04) and a history of amphetamine use (OR=1.57, 95% CI 1.09–2.33, p<0.04). Originality/value Cognitive decline should be a cause for concern amongst Thai hill-tribe older people, especially amongst those in the group with a history of amphetamine use. However, Thai health care professionals need to be aware of the potential cultural bias in the MMSE Thai 2002 version as a cognition test targeted at the hill-tribe population as the questionnaire may not provide a true reflection of their cultural experience and background.

Dual diagnosis in older drinkers during the COVID-19 pandemic

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Rahul Rao ◽  
Christoph Mueller ◽  
Matthew Broadbent
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Alcohol Use ◽  
Mental Health Services ◽  
Health Services ◽  
Older People ◽  
Substance Use Disorder ◽  
Dual Diagnosis ◽  
Opioid Use ◽  
Content Type

Purpose There is a dearth of literature examining the impact of the COVID-19 pandemic on older people with dual diagnosis referred to mental health services. The purpose of this study was to compare dual diagnosis before and after lockdown in people aged between 55 and 74 with alcohol use. Design/methodology/approach Data were collected for people referred to mental health services using an anonymised database of de-identified records to identify people with both substance use disorder alone, or accompanied by co-existing mental disorders. Findings In total, 366 older people were assessed with the Alcohol Use Disorders Identification Test (AUDIT), 185 before and 181 after lockdown. People with dual diagnosis were more likely to be referred than those without, after compared to before lockdown (13 and 6%, respectively, p < 0.05). People with any substance use disorder with and without dual diagnosis showed an even greater likelihood of referral after, compared with before, lockdown (61 and 34%, respectively, p < 0.0001). Opioid use more than once a month was more likely to be reported after, compared with before, lockdown (66 and 36%, respectively, p < 0.005). Research limitations/implications The finding of a higher likelihood of opioid use after compared with before lockdown during the COVID-19 pandemic warrants further exploration. There is also further scope for further studies that involve older non-drinkers. Originality/value A greater likelihood of both dual diagnosis and substance use disorder alone after, compared with before lockdown has implications for both mental health and addiction service provision during a pandemic.

Cognitive impairment in older people with alcohol use disorders in a UK community mental health service

2016 ◽  
Vol 9 (4) ◽  
pp. 154-158 ◽  
Author(s):  
Rahul Rao
Keyword(s):  
Mental Health ◽  
Cognitive Impairment ◽  
Alcohol Use ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Services ◽  
Older People ◽  
Alcohol Use Disorders ◽  
Drinking Behaviour ◽  
Content Type

Purpose The assessment of cognitive impairment in community services for older people remains under-explored. The paper aims to discuss this issue. Design/methodology/approach Cognitive impairment was examined in 25 people aged 65 and over with alcohol use disorders, on the caseload of community mental health services over a six-month period. All subjects assessed using Addenbrooke’s Cognitive Assessment (ACE-III). Findings In total, 76 per cent of the group scored below the cut-off point for likely dementia but only 45 per cent of people scored below the cut-off point for tests of language, compared with 68-84 per cent people in other domains. Research limitations/implications This finding has implications for the detection of alcohol-related brain cognitive impairment in clinical settings. Practical implications Standardised cognitive testing is common within mental health services for older people, but may also have utility within addiction services. Social implications The early detection of alcohol-related cognitive impairment can improve social outcomes in both drinking behaviour and the social consequences of alcohol-related dementia. Originality/value This may be the first published study of cognitive impairment in patients under a mental team for older people with alcohol use disorders and offers some unique findings within this sampling frame.

College Students’ Alcohol Use: A Critical Review

2005 ◽  
Vol 23 (1) ◽  
pp. 179-211 ◽  
Author(s):  
Carol J. Boyd ◽  
Sean E. McCabe ◽  
Michele Morales
Keyword(s):  
College Students ◽  
Alcohol Use ◽  
Binge Drinking ◽  
Critical Review ◽  
College Drinking ◽  
Future Research ◽  
Risky Drinking ◽  
Research Papers ◽  
Reference Center ◽  
Initial List

This integrative review of college students’ alcohol use covers research papers as well as review and theoretical papers published between 1990 and 2004. To conduct this review, abstracts were identified by searching Medline (PubMed), Ingenta, ERIC, PsycInfo, and Health Reference Center Academic using the following words: alcohol and college drinking, binge drinking, college students and undergraduates and the years 1990 to 2004. From an initial list of over 400 abstracts, 203 papers were identified and considered for this review. A developmental perspective of college drinking was assumed, and the chapter is organized within five domains: biology, identity, cognition, affiliation, and achievement. In addition, research pertaining to the harmful consequences of college drinking and the assessment of risky drinking is reviewed and discussed. The chapter concludes with the identification of gaps in knowledge and implications for future research.

Alcohol related brain damage – a case of neglect?

2014 ◽  
Vol 7 (3) ◽  
pp. 129-136
Author(s):  
Charlie Place
Keyword(s):  
Cognitive Impairment ◽  
Brain Damage ◽  
Dual Diagnosis ◽  
Design Methodology ◽  
Content Type ◽  
The Past ◽  
Raising Awareness ◽  
Korsakoff Syndrome ◽  
Specialist Services ◽  
Wide Range

Purpose – The purpose of this paper is to argue that alcohol-related brain damage (ARBD) is a neglected problem. ARBD is a term that has begun to be used over the past decade to describe prolonged cognitive impairment caused by alcohol use, including Wernicke's encephalopathy and Korsakoff syndrome, alcohol dementia and alcohol-related brain injury. Design/methodology/approach – The paper provides an overview of ARBD describing the research around its prevalence and prognosis. There is a consensus in the literature that there is little research and a lack of awareness of this condition. The author uses case studies from his own experience working with people with ARBD to describe the difficulties in accessing appropriate assessment and care for this group, and suggests that they are often excluded in a way that is familiar from the experience of the person with “dual diagnosis”. Findings – Recommendations are made including raising awareness, improving screening for cognitive impairment and developing specialist services. Originality/value – ARBD appears to have been neglected in the “dual diagnosis” world and this paper attempts to address this, and so should be of interest to a wide range of professionals working with substance use, mental health, homelessness and social work.

Cognitive screening assessment in Thai older adults: a prospective study of the reliability and validity of the Abbreviated Mental Test

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Kamonthip Tanglakmankhong ◽  
Benjamin M Hampstead ◽  
Robert J Ploutz-Snyder ◽  
Kathleen Potempa
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Reliability And Validity ◽  
Cognitive Screening ◽  
Mental Test ◽  
Content Type ◽  
Village Health Volunteers ◽  
Screening Assessment ◽  
Abbreviated Mental Test ◽  
Village Health

PurposeThe purpose of this paper is to examine the reliability and validity of the Abbreviated Mental Test (AMT) and the agreement with the Mini-Mental State Examination (MMSE).Design/methodology/approachThis cross-sectional study included 446 older adults who were recruited by cluster sampling from 200,481 adults aged more than 60 years. For each participant, the AMT was administered by village health volunteers and, on a separate day, by a trained professional who also administered the MMSE. Descriptive statistics, Bland and Altman levels of agreement, and Receiver Operator Curves (ROCs) were used to analyze data.FindingsAdministration of the AMT by village health volunteers during the annual health screening found cognitive impairment in only 1.12% of the sample. When the AMT was given to these same individuals by trained professionals, the rate of cognitive impairment was almost 24 times greater. Two items in the Thai AMT may require modification due to markedly elevated failure rates. At the cut score of 8, the sensitivity and specificity of the AMT relative to the MMSE were moderate (78.83 and 66.67%, respectively). The degree of agreement between AMT and MMSE was 0.49 (p < 0.001) and the correlation between the difference scores and the mean is exceptionally low (0.048).Originality/valueReliable and valid cognitive screening assessment requires the administrator to be well trained and the tools to be appropriate for the population. Although AMT is short and easy for a nonprofessional to administer, some items were not suitable due to construct validity and contextual issues.

scholarly journals Mini-Addenbrooke’s Cognitive Examination (MACE): a Useful Cognitive Screening Instrument in Older People?

2020 ◽  
Vol 23 (2) ◽  
pp. 199-204
Author(s):  
A.J. Larner
Keyword(s):  
Cognitive Impairment ◽  
Older People ◽  
Screening Instrument ◽  
Disease Prevalence ◽  
Test Accuracy ◽  
Cognitive Screening ◽  
Older Patient ◽  
Cross Sectional ◽  
Predictive Values ◽  
Addenbrooke’S Cognitive Examination

Background The Mini-Addenbrooke’s Cognitive Examination (MACE) is a recently described brief cognitive screening instrument. Objective To examine the test accuracy of MACE for the identification of dementia and mild cognitive impairment (MCI) in a cohort of older patients assessed in a neurology-led dedicated cognitive disorders clinic. Methods Cross-sectional assessment of consecutive patients with MACE was performed independent of the reference standard diagnosis based on clinical interview of patient and, where possible, informant and structural brain imaging, and applying standard clinical diagnostic criteria for dementia and MCI. Various test accuracy metrics were examined at two MACE cut-offs ( ≤ 25/30 and ≤ 21/30), comparing the whole patient cohort with those aged ≥ 65 or ≥ 75 years, hence at different disease prevalences. Results Dependent upon the chosen cut-off, MACE was either very sensitive or very specific for the identification of any cognitive impairment in the older patient cohorts with increased disease prevalence. However, at both cut-offs the positive predictive values and post-test odds increased in the older patient cohorts. At the more sensitive cut-off, improvements in some new unitary test metrics were also seen. Conclusion MACE is a valid instrument for identification of cognitive impairment in older people. Test accuracy metrics may differ with disease prevalence.

scholarly journals A review of factors associated with patterns of drinking during pregnancy

2019 ◽  
Vol 13 (1) ◽  
pp. 6-23
Author(s):  
Mark McKeague ◽  
Sam Norton ◽  
Martha Canfield
Keyword(s):  
Mental Health ◽  
Alcohol Consumption ◽  
Alcohol Use ◽  
Binge Drinking ◽  
Drinking Patterns ◽  
Content Type ◽  
Moderate Drinking ◽  
Factors Associated ◽  
Patterns Of Drinking ◽  
In Pregnancy

Purpose The purpose of this paper is to identify factors associated with drinking patterns during pregnancy. Design/methodology/approach A rapid evidence assessment was undertaken, scanning multiple databases for studies examining factors associated with alcohol consumption in pregnancy. Studies were included if they stratified data according to quantity of alcohol consumed and identified relevant associated factors. Drinking patterns were classified as light/moderate and heavy/binge. Findings In total, 15 studies were included (N=7 light/moderate; N=15 heavy/binge drinking). Factors associated with alcohol consumption during pregnancy included: smoking, age, SES, marital status, pre-pregnancy substance use and parity. While few studies reported an association between heavy/binge drinking and maternal mental health, none of the studies included explored the association between mental health and light/moderate drinking. Research limitations/implications Relatively few studies have looked at the association between psychological characteristics of women and their drinking patterns. There is a lack of articles examining light/moderate drinking in pregnancy compared to heavy/binge drinking. Moreover, there is marked variation in how alcohol use is measured. Further studies are needed to increase understanding of the association between psychological factors and patterns of drinking during pregnancy, and how health professionals might support women in this context. Originality/value The authors expand on previous work by examining two different patterns of alcohol consumption in pregnancy, rather than alcohol use simply as an isolated concept. The two groups were found to differ in a number of demographic and social factors. This information could be used to aid healthcare professionals in targeting specific interventions to those women most at risk.

Identifying and responding to alcohol misuse in memory clinics: current practice, barriers and facilitators

2015 ◽  
Vol 8 (2) ◽  
pp. 65-77
Author(s):  
Anna Thake ◽  
Sarah Wadd ◽  
Kim Edwards ◽  
James Randall-James
Keyword(s):  
Cognitive Impairment ◽  
Alcohol Use ◽  
Current Practice ◽  
Alcohol Misuse ◽  
Family Members ◽  
Alcohol Screening ◽  
Alcohol Problems ◽  
Barriers And Facilitators ◽  
Content Type ◽  
Memory Clinics

Purpose – The purpose of this paper is to explore current practice, barriers and facilitators to identifying and responding to alcohol problems in memory clinics. Design/methodology/approach – A questionnaire sent to professionals in 55 memory clinics in England, Wales and the Isle of Wight and two focus groups with professionals from three memory clinics in England. Findings – Only 1/35 clinics that responded to the questionnaire was using a standardised alcohol screening tool but all attempted to gain some information about alcohol use. Without screening tools, practitioners found it difficult to determine whether alcohol use was problematic. Barriers to identification/intervention included cognitive impairment, service-user being “on guard” during assessment, presence of family members/carers, time constraints and a perception that brief interventions were not within the remit of memory clinics. Facilitators were obtaining visual clues of problem drinking during home visits and collateral information from family members/carers. Research limitations/implications – Focus group participants were recruited through convenience sampling and a small number of professionals took part. This means that the findings may be subject to selection bias and limits the generalisability of the findings. Practical implications – Memory clinics should provide guidance and training for practitioners on how to intervene and respond to alcohol misuse. Further research is required to determine the most effective way to identify alcohol problems in people with cognitive impairment and how to deliver brief alcohol interventions that take account of cognitive deficits. Originality/value – This is the first study to examine alcohol screening and interventions in memory clinics and identifies a need for guidance, training and further research.

Alcohol and public mental health for older people: 20 years of UK policy change

2020 ◽  
Vol 19 (3) ◽  
pp. 231-239
Author(s):  
Rahul Tony Rao
Keyword(s):  
Public Health ◽  
Older People ◽  
Dual Diagnosis ◽  
Alcohol Misuse ◽  
Public Mental Health ◽  
Content Type ◽  
Alcohol Related Harm ◽  
Related Harm ◽  
Research And Policy ◽  
Improve Health

Purpose The purpose of this paper is to detail developments in UK alcohol policy for older people over the past 20 years, based on evidence for a growing public health problem with alcohol misuse in older people. Design/methodology/approach A literature search was carried out using health and social care databases, including grey literature. Findings There has been considerable progress in areas such as screening and brief intervention, low-risk drinking and service provision for integrated care in older people with dual diagnosis. Research limitations/implications There remains a dearth of research and policy for older people with alcohol misuse and dual diagnosis prior to 2011. Although there remains limited empirical evidence for public health interventions to improve health outcomes from alcohol-related harm, improvements in population health from implementation of recent policy changes and intervention programmes remains to be seen. Practical implications This review has implications for best practice in the provision of integrated care to reduce harm and improve health and social outcomes in older people with alcohol misuse and dual diagnosis. Originality/value This review draws together a large area of research and policy on alcohol misuse in older people that has the potential to improve public mental health for older people who are at risk of alcohol-related harm.

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