Older people and alcohol: Royal College of Psychiatrists gets screening wrong

Much ado about the RCPsych report out today on ‘Our invisible addicts’; supposedly, older people addicted to drugs or alcohol.

I don’t think this is a new concern. Part of the ‘problem’ is that the care of people with addictions has slowly got better and people are living  longer. Northern Doctor has written very well on this before.

Unfortunately, the new report, which is written by psychiatrists, people with an interest in addiction and one GP specialist in addiction, does not seem to understand what GPs do or what screening is.

They state that:

“General practitioners should screen every person over 65 years of age for substance misuse as part of a routine health check, using specific tools such as the Short Michigan Alcoholism Screening Test – Geriatric version (SMAST-G); screening should also incorporate cognitive testing using tools such as the Mini-Mental State Examination (MMSE)”.
I’m not sure what health checks they think we do for 65 year olds. A blood pressure every 5 years is recommended, and vascular risk checks go on in varying ways across the country, usually depending on what the background risk of cardiovascular disease is. (I have issues with this, but that’s for another time.) Apart from this, we don’t call patients in for a general ‘check-up’. The authors are recommending introduction of a new screening test for all our patients aged 65 and up. There is a lack of evidence about whether this will improve outcomes in people who are well and with no complaints. Nor has this proposal been approved by NHS Screening. The MMSE examination is used to test patients who complain about memory problems; it’s not used as a screening test for well people with no symptoms.
There is a big difference. Someone  who is drinking alcohol and has recurrent falls, or is concerned about their memory, or is treating symptoms of anxiety with alcohol, will normally be asked about alcohol because it is relevant. They will also be asked about a lot of other things. It’s part of the overall assessment.
For other people who are perfectly well, it is highly questionable that GPs should start a new screening programme, which is lacking in evidence of efficiency, and without proper consultation or outcomes analysis.  There is also the issue of harm: The report authors suggest that a ‘binge drink’ for a woman over 65 is more than 3 units of alcohol in  a day. They don’t provide individual references for this decision (US research tends to stick to 5 units) . But if you were a fit and healthy 65 year old woman, and had three units of alcohol once a weekend, would you really want to tell your doctor about your supposed ‘binge drinking’ ?

3 Responses to “Older people and alcohol: Royal College of Psychiatrists gets screening wrong”

  1. Anna :o] June 24, 2011 at 1:07 am #

    Excellent post.

    I have written my own regarding this nannying/health police proclamation. It is offensive and that is all there is to it. As you rightly say – if a GP suspected problems they – the patient – would be asked about it. To ‘suspect’ and cross examine everyone over sixty-five re substance abuse is grossly offensive.

    Anna :o]

  2. Paul Smith June 26, 2011 at 11:55 am #

    A very interesting article which gets us all thinking but the report is way off mark.

    Drinking alcohol is not bad for you, infact in moderate amounts it’s been proved to be good for ones heart, trying to insinuate that the UK has hundreds of thousands of elderly alcoholics is absurd, it is not the elderly who have drinking problems but the youth and very young children, it is not elderly pensioners who we see causing fights outside nightclubs on friday nights, it’s not elderly mobility scooter riders who we see getting drunk and running down pedestrians,

    I have no doubt whatsoever this country is introducing American ideas to health policies, we are seeing it happen in Welfare Reform, the danger with adopting Americanisms is that theyn generally don’t help the poor people, the people who really need help, soon we shall see the end of the NHS as we all grew up to respect and appreciate, following anything America does is just following the path to heartache.

    My grandfather was 98 when he died and he drank two pints of bitter a day and smoked 40 tabs a day, he would of got to a hundred had it not been for a coal waggon running him over, I’m off to have a pint of lager in my back garden…

  3. Mike ('Dr M's Rare Patiant';) July 12, 2011 at 11:39 am #

    It ended with a laugh at least! “Here here!” to Anna and thanks for the smile Paul. Enjoy your Lager in the garden.
    I am almost 65 and strongly object to all the above plus being called “Geriatric”! What a nerve! Any person over 60 is still a person, even when 90 and perhaps suffering “wear and tear” dis-ease.

    I see “my lovely Dr.” 😉 perhaps once every two years to five? Taijiquan and Kung Fu are my friends and stave off many “stagnations”. Beer? Yes please! At home in the evenings I have roughly 3 tins (2.6 pints) on average, maybe 4 pints of ale on Fridays; as the pub’s open longer. If you eat a good diet (Veggie, of course, as our bodies are designed for it) and exercise at least 3 times a week then you should not have too many problems.
    As for these “tests”, they are just insulting and about as accurate as an ill-informed guess. Do you uses mathematics every day? Are the order of the months, backwards, something that you normally think about? Nonsense. The people who dream up these childish things need something better to do.
    My old mother died at 94, had about 3 *Guinness every day of her adult life and used to smoke like a chimney. What finished her off was the Nursing Home (drugs and stagnation) and the NHS at James Paget (MRSI+). Were it not for that she’s have seen 100!
    *Beware of too much Gunness and “Iron Overload Disease” as this is why she was forced into a Nursing Home and was misdiagnosed. Change the Guinness for Real Ale!

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