Older people remain invisible in alcohol treatment studies
Sir
The study by Professor Orford and colleagues is not only
groundbreaking in its methodological approach, but the comparitive
clinical effectiveness of social and psychological treatments for alcohol
misuse is equally noteworthy.
However, an observation that appears to be a sad reflection of modern
alcohol treatment services as represented by the study is the under-
representation of older people within treatment settings.
Although there is general consistency in the observation that alcohol
use and misuse decreases with advancing age, in the UK, about 1 in 5 men
over the age of 65 drink above sensible limits [1]. The influence of
ethnicity is also relevant, given that Irish men are over-represented in
alcohol treatment services [2]and it is possible that this may continue
into later life. There was no breakdown of ethnicity in the study, which
may have shed some light on this.
Although it is likely that older people are more likely to present to
medical services than secondary mental health services [3], there is some
limited evidence that this age group can benefit from treatment,
especially brief advice and motivational enhancement therapy [4, 5].
There appears to be immense scope for replicating the current study
in older people, particularly given the relevance of social factors in the
development and maintenance of alcohol misuse. Finding a large enough
sample may be a more difficult endeavour.
REFERENCES
[1] Statistics on Alcohol: England, 2003. London: Department of
Health, 2003
[2] Commander MJ, Odell S, Sashidharan SP, Surtees PG. Psychiatric
morbidity in people born in Ireland. Soc Psychiatry Psychiat
Epidemiol 1999;34:565-569.
[3] Mulinga JD. Elderly people with alcohol-related problems: Where
do they go? Int J Ger Psychiat 1999;14: 564-566.
[4] Gordon AJ, Conigliaro J, Maisto SA et al. Comparison of
consumption effects of brief interventions for hazardous drinking elderly.
Subst. Use Misuse
2003;38:1017-1035.
[5] Fleming MF, Manwell LB, Barry KL. et al. Brief physician advice
for alcohol problems in older adults: A randomized community-based
trial. J Fam Prac 1999;48:378-384
Competing interests:
MSc student in Clinical and Public Health Aspects of Addiction at Institute of Psychiatry.
Recently given an interview to the Sunday Times on health consequences (in middle and later life) of drinking over sensible limits. This received no financial remuneration.
Competing interests:
No competing interests
09 September 2005
Rahul Rao
Consultant and Honorary Senior Lecturer in Old Age Psychiatry
Job Ward, Thomas Guy House, Guy's Hospital, 47 Weston Street, London SE1 3RR
Rapid Response:
Older people remain invisible in alcohol treatment studies
Sir
The study by Professor Orford and colleagues is not only
groundbreaking in its methodological approach, but the comparitive
clinical effectiveness of social and psychological treatments for alcohol
misuse is equally noteworthy.
However, an observation that appears to be a sad reflection of modern
alcohol treatment services as represented by the study is the under-
representation of older people within treatment settings.
Although there is general consistency in the observation that alcohol
use and misuse decreases with advancing age, in the UK, about 1 in 5 men
over the age of 65 drink above sensible limits [1]. The influence of
ethnicity is also relevant, given that Irish men are over-represented in
alcohol treatment services [2]and it is possible that this may continue
into later life. There was no breakdown of ethnicity in the study, which
may have shed some light on this.
Although it is likely that older people are more likely to present to
medical services than secondary mental health services [3], there is some
limited evidence that this age group can benefit from treatment,
especially brief advice and motivational enhancement therapy [4, 5].
There appears to be immense scope for replicating the current study
in older people, particularly given the relevance of social factors in the
development and maintenance of alcohol misuse. Finding a large enough
sample may be a more difficult endeavour.
REFERENCES
[1] Statistics on Alcohol: England, 2003. London: Department of
Health, 2003
[2] Commander MJ, Odell S, Sashidharan SP, Surtees PG. Psychiatric
morbidity in people born in Ireland. Soc Psychiatry Psychiat
Epidemiol 1999;34:565-569.
[3] Mulinga JD. Elderly people with alcohol-related problems: Where
do they go? Int J Ger Psychiat 1999;14: 564-566.
[4] Gordon AJ, Conigliaro J, Maisto SA et al. Comparison of
consumption effects of brief interventions for hazardous drinking elderly.
Subst. Use Misuse
2003;38:1017-1035.
[5] Fleming MF, Manwell LB, Barry KL. et al. Brief physician advice
for alcohol problems in older adults: A randomized community-based
trial. J Fam Prac 1999;48:378-384
Competing interests:
MSc student in Clinical and Public Health Aspects of Addiction at Institute of Psychiatry.
Recently given an interview to the Sunday Times on health consequences (in middle and later life) of drinking over sensible limits. This received no financial remuneration.
Competing interests: No competing interests