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’ ?