Rahul Rao

Addiction and ageing–awareness, assessment and action

Acknowledgement of increasing prevalence of substance problems in older people in an ageing population, on a backdrop of paucity of research and designated service provision in the UK, moved the Royal College of Psychiatrists to produce a report ‘Our invisible addicts’ [1]. There was an unexpected reaction by the public and press to the Report. Some—though by no means all—were disapproving, even angry, particularly about the suggestion that some consideration should be given to a review of lower ‘safe limits’ for alcohol consumption in older people. Taken as a whole, the response reflected the considerable stigma about substance use especially in the older population. It further demonstrated a general lack of understanding of the issues. Older people themselves, families, carers, and some professionals, may be unaware of the nature, degree and implications of substance use and misuse, and if they are aware, might collude in denying or downplaying its presence. Increased use and misuse of legal substances, including prescription and over the counter medications, and illegal drugs, by older people, is being reported in European and North American national epidemiological surveys of consumption of alcohol and drugs, presentations to specialist addiction services and admissions to a range of clinical units [1–6]. Projections in the USA have indicated that the numbers of people aged 50 or older with substance use disorder is likely to double between 2000 and 2020 [7].

Alcohol use and alcohol-use disorders among older adults in India: a literature review

Objectives: With changing attitudes to alcohol and an increasing life span in India, the prevalence of alcohol use and misuse in successive cohorts of older people is likely to increase. In this paper, we attempt to review the most recent evidence covering alcohol use and alcohol-use disorders in the Indian elderly. Methods: PubMed, PsycINFO and Indmed databases were searched using relevant keywords. Papers meeting eligibility criteria were selected through a sequential process of screening title, abstract and full text. Data were extracted into Excel sheets. Results: There was a dearth of pan-national studies. There were several methodological issues with many studies especially related to measurement. A substantial proportion of individuals above the age of 50 years are current consumers of alcohol and the prevalence is generally higher in urban compared to rural areas. Older women are generally likely to be alcohol abstainers. The general trend appears to be a reduction in current drinking among successive age cohorts over the age of 50. Alcohol consumption in the older adults is associated with educational status, health status, chronic morbidity, employment status, socioeconomic status, auditory/locomotor impairment and asthma. Conclusion: Alcohol use and misuse is a problem among the Indian older adults. With socio-demographic changes that will further increase longevity, this problem is likely to increase and policy-makers need to plan for it. Future research needs to improve validity and reliability in study methodology, as well as add to the current evidence base.

Substance misuse in older people

Baby boomers are the population at highest risk

Vascular cognitive impairment and vascular dementia

Vascular dementia is the second-most-common type of dementia. Vascular cognitive impairment is a term encompassing vascular dementia as well as milder forms of pre-dementia cognitive impairment related to vascular damage that do not meet the criteria for a diagnosis of dementia. Early diagnosis of cerebrovascular disease, including silent infarcts and small vessel disease is difficult, but important, as modification of cardiovascular risk factors is the mainstay of management to decrease further insults and deterioration, and maintain the patient’s independence within their family and social unit.

Addressing alcohol-related dementia should involve better detection, not watchful waiting

Alcohol-related dementia represents an underrecognised mental disorder with both clinical and public mental health aspects. There is considerable scope for improving its assessment within both mainstream and specialist mental health services, but ongoing challenges remain in ensuring its timely detection so that appropriate preventative and rehabilitative interventions can be applied. Declaration of interest None.

Improving the career prospects of international medical graduates

Simpson’s essay on the role of international medical graduates is a surreal biography of my own personal life and medical career.1 In the late 1960s, an acute shortage of doctors in certain specialties across England led to recruitment of doctors from outside Europe, mostly from the Asian subcontinent.2 As the son of two such doctors, the reality of how they were treated is ingrained …

Methodological difficulties of studying alcohol consumption and dementia

Examining the association between alcohol consumption and cognitive impairment is fraught with methodological difficulties, and the results of Sabia and colleagues’ study should be interpreted with a high degree of caution.1 The study tells us little about how drinking above low risk guidance beyond the of age of 55 affects the development of …

Managing older people's alcohol misuse in primary care.

> ‘It would be too optimistic to suppose that the relative under-representation of subjects in the older age groups … is just explained by older people having generally got the treatment they required … it seems likely that this finding is in part a hint of the diminished life expectancy of the alcoholic.’ > > (Professor Griffith Edwards, 19671) Over the past 50 years, increased life expectancy has changed the demographic structure of the UK population. This has had profound consequences for corresponding changes in lifestyle and health. Four years ago, we highlighted the alarming trend of rising alcohol misuse among older people in the UK.2 Even using more refined ways of measuring the burden of alcohol-related illness, hospital admissions that are wholly attributable to alcohol for people aged ≥65 years in England have nearly doubled over the past 6 years (Figure 1).3 A rise of over >90% in the number of admissions for people aged ≥65 years far outstrips the rise in overall numbers of people in this age group.4 Therefore, strategies are clearly needed to address alcohol misuse by identifying and targeting appropriate areas for clinical intervention Figure 1. Trends in alcohol specific admissions to hospitals in England. Alcohol use and misuse in older people is easy to overlook in primary care settings. There may be unintentional ageism by carers, where sleep problems are attributed to someone being ‘always a poor sleeper’, or appetite problems labelled as a lifelong fastidiousness with food. Older people may be stigmatised and under-report their alcohol intake for fear of being …

Improving the coaching and mentoring of IMGs

With both parents being staff and associate specialist doctors, since the early 1960s I witnessed the trials and tribulations experienced by the first immigrants working in the NHS.1 Not only did they face stark career choices, they often worked in shortage specialties such as geriatrics and psychiatry, sometimes with a lifetime of feeling that the NHS could have served them better. …

Loss of Office for National Statistics data will increase health inequalities

I have spent the past 15 years using data from the Office for National Statistics to inform policy and improve service delivery in relation to the growing trend of alcohol misuse in older people (www.alcoholandolderhealth.co.uk).1 These data have led to the publication of a landmark report and series of articles that include epidemiological and demographic aspects …