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.

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.

scholarly journals Update on the management of alcohol use disorders

2019 ◽  
Vol 26 (2) ◽  
pp. 82-91
Author(s):  
Julia M. A. Sinclair ◽  
Aimee O'Neill
Keyword(s):  
Mental Health ◽  
Alcohol Use ◽  
Mental Health Services ◽  
Health Services ◽  
Alcohol Use Disorders ◽  
Teachable Moment ◽  
Management Options

SUMMARYAlcohol use disorders (AUD) are common, particularly in patients attending mental health services. Clinicians are often hesitant to explore with patients their relationship with alcohol and the role that it has in their presenting complaint, despite being ideally placed to optimise on a ‘teachable moment’ and initiate treatment, where necessary. This article provides an overview of AUD and their identification and management options.

scholarly journals The development and implementation of a peer support model for a specialist mental health service for older people: lessons learned

2018 ◽  
Vol 23 (2) ◽  
pp. 73-85
Author(s):  
Dominiek Coates ◽  
Patrick Livermore ◽  
Raichel Green
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Mental Health Services ◽  
Health Service ◽  
Health Services ◽  
Older People ◽  
Implementation Barriers ◽  
Content Type ◽  
Specialist Mental Health Service ◽  
Work Model

Purpose There has been a significant growth in the employment of peer workers over the past decade in youth and adult mental health settings. Peer work in mental health services for older people is less developed, and there are no existing peer work models for specialist mental health services for older people in Australia. The authors developed and implemented a peer work model for older consumers and carers of a specialist mental health service. The purpose of this paper is to describe the model, outline the implementation barriers experienced and lesson learned and comment on the acceptability of the model from the perspective of stakeholders. Design/methodology/approach To ensure the development of the peer work model met the needs of key stakeholders, the authors adopted an evaluation process that occurred alongside the development of the model, informed by action research principles. To identify stakeholder preferences, implementation barriers and potential solutions, and gain insight into the acceptability and perceived effectiveness of the model, a range of methods were used, including focus groups with the peer workers, clinicians and steering committee, consumer and carer surveys, field notes and examination of project documentation. Findings While the model was overall well received by stakeholders, the authors experienced a range of challenges and implementation barriers, in particular around governance, integrating the model into existing systems, and initial resistance to peer work from clinical staff. Originality/value Older peer workers provide a valuable contribution to the mental health sector through the unique combination of lived experience and ageing. The authors recommend that models of care are developed prior to implementation so that there is clarity around governance, management, reporting lines and management of confidentiality issues.

scholarly journals Advanced care planning: an exploratory study of community-based mental health practitioners’ views and experiences of ACP in practice with people with dementia

2019 ◽  
Vol 23 (4) ◽  
pp. 195-207
Author(s):  
Jill Manthorpe ◽  
Kevin Goodwin
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Services ◽  
Mental Health Professionals ◽  
Exploratory Study ◽  
Community Mental Health Services ◽  
Content Type ◽  
People With Dementia ◽  
Health Trust

Purpose Advanced care planning (ACP) involves the discussion of preferences relevant to a possible future time when one’s ability to make decisions may be compromised. ACP is considered as having potential to enhance choice and control and thereby to improve the experience of care for people with dementia and their carers. Care coordinators have been highlighted as possibly playing a central role in facilitating these discussions among people with long-term care needs. However, there is limited evidence of how ACP is facilitated by community mental health professionals who may be supporting people with dementia and carers. The paper aims to discuss this issue. Design/methodology/approach This exploratory study took the form of qualitative semi-structured interviews to explore the views and experiences of community mental health professionals when discussing ACP with people with dementia and/or their carers. A convenience sample of 14 participants working in community mental health services in one NHS Mental Health Trust in London, England, was recruited and interview data were analysed using a framework approach. Findings Five themes emerged from the interviews – knowledge and experience, use of ACP, inhibitors of discussion, service influences and the future. The depth of ACP facilitation appeared dependent on the knowledge, confidence and skills of the individual professional. Limited resources leading to service rationing were cited as a major barrier to ACP engagement. Helping people with dementia and their carers with ACP was not viewed as a priority in the face of competing and increasing demands. A further organisational barrier was whether ACP was viewed by service managers as “core business”. Findings indicate that practice was generally to refer people with dementia to other agencies for ACP discussions. However, pockets of ACP practice were reported, such as explaining proxy decision making options for finances. Research limitations/implications This exploratory study took place in the community mental health services in one NHS Mental Health Trust that may not be representative of other such teams. Case records were not scrutinised or clinical conversations with people with dementia or carers. Practical implications Barriers to initiating ACP discussions were cited, such as limited resources, lack of time and knowledge; unclear role remit, uncertain service direction and poor documentation sharing processes. However, participants held a common belief that ACP for people with dementia is potentially important and were interested in training, a greater team focus on ACP and pathway development. This indicates the potential for staff development and continuing professional development. Originality/value Few studies have asked a wide range of members of community mental health services about their knowledge, skills and confidence in ACP and this study suggests the value of taking a team-wide approach rather than uni-professional initiatives.

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