Retirement, bereavement, change in home situation, infrequent contact with family and friends, and social isolation leading to an increase in alcohol consumption by older people

British Medical Journal, Substance misuse in older people, 22 August 2017:

Baby boomers are the population at highest risk

Developed countries have seen substantial increases in longevity over the past 20 years, contributing to a global demographic shift. The number of older people (aged over 50) experiencing problems from substance misuse is also growing rapidly, with the numbers receiving treatment expected to treble in the United States and double in Europe by 2020.1

In both the UK and Australia, risky drinking is declining, except among people aged 50 years and older.23 There is also a strong upward trend for episodic heavy drinking in this age group. This generational trend is not restricted to alcohol. In Australia, the largest percentage increase in drug misuse between 2013 and 2016 was among people aged 60 and over, with this age group mainly misusing prescription drugs. However, people over 50 also have higher rates than younger age groups for both past year and lifetime illicit drug misuse (notably cannabis).4

Of additional concern is the increasing proportion of women drinking in later life, particularly those whose alcohol consumption is triggered by life events such as retirement, bereavement, change in home situation, infrequent contact with family and friends, and social isolation. The rise of alcohol misuse in "baby boomers" (people born between 1946 and 1964) has also been noted in Asian countries.5

Older people with substance misuse show different characteristics but most fall into one of three groups: maintainers (unchanged lifetime patterns), survivors (long term problem users), and reactors (later uptake or increased patterns). The distinction is important because each requires different assessment, intervention, and treatment regimens.6

With alcohol being the most common substance of misuse among older people, underdetection of alcohol problems is of immediate concern. Alcohol misuse in the older population may increase further as baby boomers get older because of their more liberal views towards, and higher use of, alcohol. A lack of sound alcohol screening to detect risky drinking may result in a greater need for treatment, longer duration of treatment, heavier use of ambulance services, and higher rates of hospital admission.

Two systematic reviews of both descriptive and analytical trials found that treatment programmes adapted for older people with substance misuse were associated with better outcomes than programmes aimed at all age groups.78 Age adapted programmes resulted in less severe addiction, higher rates of abstinence, improved health status, and better aftercare. Assessment, treatment, and recovery plans require careful consideration of age specific clinical needs. Professionals need to consider the possibility of coexisting mental disorders such as cognitive impairment and depression (dual diagnosis), as well as complex physical presentations that may include the presence of pain, insomnia, or the non-medical use of prescription drugs. Older people with dual diagnosis use both inpatient and outpatient services more frequently than those with substance misuse alone.9 The management of substance use in older people can also be influenced by mental capacity, which may change with the onset of cognitive impairment.

Future healthcare for older people with substance misuse will continue to present challenges for service delivery, particularly with the growing influence of baby boomers. Some of the recommendations from the 2011 Royal College of Psychiatrists' report on substance misuse in older people (Our Invisible Addicts),10 such as examining safe drinking limits for older people, developing age specific skills in the assessment and treatment of substance misuse, and adapting services have been incorporated into an information guide for clinical practice.11 In the United States, the importance of better education for clinicians has already been noted.12 In the UK, a revision of Our Invisible Addicts is under way.

The baby boomer population also brings challenges to the diagnostic process, given the complexity of clinical presentations. Clinicians will need improved knowledge and skills in assessing and treating older people at risk of misuse of opiate prescription drugs, cannabis, and, increasingly, gabapentinoid drugs used to treat neuropathic pain and anxiety.13

Guidance for service commissioners has begun to acknowledge the needs of older people with substance misuse, particularly in the context of dual diagnosis.14 The Drink Wise Age Well project in the UK has also started to evaluate interventions for alcohol misuse in older people.15 But there remains an urgent need for better drug treatments for older people with substance misuse, more widespread training, and above all a stronger evidence base for both prevention and treatment.

The clinical complexity of older adults with substance misuse demands new solutions to a rapidly growing problem. So far, there has been little sign of a coordinated international approach to integrated care.

References

1.     ↵

Wu LT, Blazer DG. Substance use disorders and psychiatric comorbidity in mid and later life: a review. Int J Epidemiol2014;358:304-17. doi:10.1093/ije/dyt173 pmid:24163278.

2.     ↵

Office for National Statistics. Adult drinking habits in Great Britain: 2005 to 2016. 2017.https://www.ons.gov.uk/releases/adultdrinkinghabitsingreatbritain2015

3.     ↵

Australian Institute of Health and Welfare. National Drug Strategy Household Survey (NDSHS) 2016: key findings. 2017.http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2016/key-findings

4.    ↵

Kostadinov V, Roche A. Bongs and baby boomers: Trends in cannabis use among older Australians. Australas J Ageing2017;358:56-9.. doi:10.1111/ajag.12357 pmid:27730759.

5.     ↵

Nadkarni A, Murthy P, Crome IB, Rao R. Alcohol use and alcohol-use disorders among older adults in India: a literature review. Aging Ment Health2013;358:979-91.. doi:10.1080/13607863.2013.793653 pmid:23659339.

6.     <![endif]>↵

Nicholas R, Roche AM. Grey matters. Preventing and responding to alcohol and other drug problems among older Australians. Information Sheet 3. The silver tsunami: the impact of Australia's ageing population.National Centre for Education and Training on Addiction, Flinders University, 2014, http://nceta.flinders.edu.au/files/7014/1679/1083/EN559.pdf.

7.     <![endif]>↵

Moy I, Crome P, Crome I, Fisher M. Systematic and narrative review of treatment for older people with substance problems. Eur Geriatr Med2011;358:212-36. doi:10.1016/j.eurger.2011.06.004.

8.     <![endif]>↵

Bhatia U, Nadkarni A, Murthy P, et al. Recent advances in treatment for older people with substance use problems: An updated systematic and narrative review. Eur Geriatr Med2015;358:580-6. doi:10.1016/j.eurger.2015.07.001.

9.     ↵

Bartels SJ, Coakley EH, Zubritsky C, et al. PRISM-E Investigators. Improving access to geriatric mental health services: a randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use. Am J Psychiatry2004;358:1455-62. https://doi.org/10.1176/appi.ajp.161.8.1455.doi:10.1176/appi.ajp.161.8.1455 pmid:15285973.

10.   ↵

Royal College of Psychiatrists. Our invisible addicts: first report of the older persons' substance misuse working group of the Royal College of Psychiatrists. 2011. http://www.rcpsych.ac.uk/files/pdfversion/cr165.pdf

11.   ↵

Rao RT, Crome I, Crome P. Substance Misuse in Older People: an Information Guide. Cross Faculty Report FR/OA/A)/01.The Royal College of Psychiatrists, 2015,https://www.rcpsych.ac.uk/pdf/Substance%20misuse%20in%20Older%20People_an%20information%20guide.pdf

12.   ↵

De Jong CAJ, Goodair C, Crome I, et al. Substance misuse education for physicians: why older people are important. Yale J Biol Med2016;358:97-103. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4797843pmid:27505022.

13.   ↵

Evoy KE, Morrison MD, Saklad SR. Abuse and misuse of pregabalin and gabapentin. Drugs2017;358:403-26.doi:10.1007/s40265-017-0700-x pmid:28144823.

14.   ↵

Public Health England. Better care for people with co-occurring mental health, and alcohol and drug use conditions. 2017.https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/625809/Co-occurring_mental_health_and_alcohol_drug_use_conditions.pdf

15.   ↵

Drink Wise Age Well. Impact report. 2016. http://www.drinkwiseagewell.org.uk/wp-content/uploads/2016/11/DWAW_AR16-LoResSpreads2.pdf

Apocalypse then, but what now?

“Political reforms are mostly ineffectual, in part because they are often aimed at the balance of power between the straightforwardly wealthy and the politically powerful, rather than the lot of the have-nots.”

Walter Scheidel, Dickason Professor in the Humanities, Professor of Classics and History, Catherine R. Kennedy and Daniel L. Grossman Fellow in Human Biology and Director of Graduate Studies in Classics at Stanford University, delivers the bad news…….

The Economist, 2 March 2017:

As a supplier of momentary relief, the Great Depression seems an unlikely candidate. But when it turns up on page 363 of Walter Scheidel’s “The Great Leveler” it feels oddly welcome. For once—and it is only once, for no other recession in American history boasts the same achievement—real wages rise and the incomes of the most affluent fall to a degree that has a “powerful impact on economic inequality”. Yes, it brought widespread suffering and dreadful misery. But it did not bring death to millions, and in that it stands out.

If that counts as relief, you can begin to imagine the scale of the woe that comes before and after. Mr Scheidel, a Vienna-born historian now at Stanford University, puts the discussion of increased inequality found in the recent work of Thomas Piketty, Anthony Atkinson, Branko Milanovic and others into a broad historical context and examines the circumstances under which it can be reduced.

Having assembled a huge range of scholarly literature to produce a survey that starts in the Stone Age, he finds that inequality within countries is almost always either high or rising, thanks to the ways that political and economic power buttress each other and both pass down generations. It does not, as some have suggested, carry within it the seeds of its own demise.

Only four things, Mr Scheidel argues, cause large-scale levelling. Epidemics and pandemics can do it, as the Black Death did when it changed the relative values of land and labour in late medieval Europe. So can the complete collapse of whole states and economic systems, as at the end of the Tang dynasty in China and the disintegration of the western Roman Empire. When everyone is pauperised, the rich lose most. Total revolution, of the Russian or Chinese sort, fits the bill. So does the 20th-century sibling of such revolutions: the war of mass-mobilisation.

And that is about it. Financial crises increase inequality as often as they decrease it. Political reforms are mostly ineffectual, in part because they are often aimed at the balance of power between the straightforwardly wealthy and the politically powerful, rather than the lot of the have-nots. Land reform, debt relief and the emancipation of slaves will not necessarily buck the trend much, though their chances of doing so a bit increase if they are violent. But violence does not in itself lead to greater equality, except on a massive scale. “Most popular unrest in history”, Mr Scheidel writes, “failed to equalise at all.”

Perhaps the most fascinating part of this book is the careful accumulation of evidence showing that mass-mobilisation warfare was the defining underlying cause of the unprecedented decrease in inequality seen across much of the Western world between 1910 and 1970 (though the merry old Great Depression lent an unusual helping hand). By demanding sacrifice from all, the deployment of national resources on such a scale under such circumstances provides an unusually strong case for soaking the rich.

Income taxes and property taxes rose spectacularly during both world wars (the top income-tax rate reached 94% in America in 1944, with property taxes peaking at 77% in 1941). Physical damage to capital goods slashed the assets of the wealthy, too, as did post-war inflations. The wars also drove up membership in trade unions—one of the war-related factors that played a part in keeping inequality low for a generation after 1945 before it started to climb back up in the 1980s……..

Read the rest of the article here.

The American Resistance has many faces - this is one of them (3)

Kirk W. Johnson ‏@KirkWJohnson 30 January 2017

@realDonaldTrump @POTUS

Click on image to enlarge

The American Resistance has many faces - this is one of them (2)

Image found at Twitter

America is leaderless in 2017

Donald John Trump was not hiding his light under a bushel until after the presidential inauguration.

When during the Republican Party preselection process and then the long national presidential election campaign Trump kept telling the world how smart he was I’m sure there were those who secretly hoped this was so and, that the content of his stump speeches, his social media rants and very limited vocabulary were in combination simply a ploy aimed at the lowest denominator on the voter spectrum.

Unfortunately for those sanguine souls President Trump’s inauguration speech on 20 January 2017, his address to the Central Intelligence Agency the next day, as well as his inflating of swearing-in ceremony crowd size before sending his press secretary out to lie on his behalf, will have dashed theses hopes.

Donald Trump remains exactly as he always presented himself and now America has a predatory oaf as its 45^th president.

One so intellectually lightweight, wilfully ignorant, boastful, bigoted, paranoid, vengeful, erratic and work-shy, that effectively the United States of America is a nation which is leaderless as it goes forward.

Who will fill the vacuum is anyone’s guess.

Will it be his immediate family framing policy and making decisions for him to strut before the cameras? Will it be his newly installed far-right captain’s picks in the White House administration running the country in spite of Trump’s inadequacies? Or will it be a combination of family members, captain's picks and Congress racing around putting out political fires as Trump uncontrollably rampages across the economic and social landscape?

The future is unknowable until it becomes the present and by then it may be too late for America.

* Netflix image found on Twitter

How Malcolm Turnbull's approval rating compares with seven other national leaders

OVERVIEW

2017 Edelman Trust Barometer:

The 2017 Edelman Trust Barometer finds that two-thirds of the countries we survey are now "distrusters" (under 50 percent trust in the mainstream institutions of business, government, media and NGOs to do what is right), up from just over half in2016. This is a profound crisis in trust that has its origins in the Great Recession of2008. The aftershocks from the stunning meltdown of the global economy are still being felt today, with consequences yet unknown.

Like the second and third waves of a tsunami, ongoing globalization and technological change are now further weakening people's trust in global institutions, which they believe have failed to protect them from the negative effects of these forces. The celebrated benefits of free trade—affordable products for mass consumption and the raising of a billion people out of poverty—have suddenly been supplanted by concerns about the outsourcing of jobs to lower-cost markets. The impact of automation is being felt, especially in lower-skilled jobs, as driverless trucks and retail stores without cashiers become reality.

We have moved beyond the point of trust being simply a key factor in product purchase or selection of employment opportunity; it is now the deciding factor in whether a society can function. As trust in institutions erodes, the basic assumptions of fairness, shared values and equal opportunity traditionally upheld by "the system" are no longer taken for granted. We observe deep disillusion on both the left and the right, who share opposition to globalization, innovation, deregulation, and multinational institutions. There is growing despair about the future, a lack of confidence in the possibility of a better life for one's family. The 2017 Edelman Trust Barometer finds that only 15 percent of the general population believe the present system is working, while 53 percent do not and 32 percent are uncertain.

MALCOLM BLIGH TURNBULL (AUSTRALIA)

Essential Report, 17 January 2017:

DONALD JOHN TRUMP (USA)

9 News, 18 January 2017:

President-elect Donald Trump takes office this week with dismal approval and popularity numbers, according to polls out Tuesday, underscoring the deep divisions among Americans as the New York businessman prepares for his inauguration.

A CNN/ORC poll showed 40 percent of respondents approved of the way Trump has been handling the transition period heading into Friday's inauguration, a figure that's sharply lower than any incoming US president in recent history.

Trump will enter the Oval Office as the least popular incoming president in at least four decades, according to a Washington Post-ABC News poll…….

The CNN poll showed Trump lagging more than 20 points behind the approval ratings of his three most recent predecessors and 44 points below that of President Barack Obama as he prepared to enter the Oval Office in 2009.

Obama had an 84 percent approval rating ahead of his inauguration, Bill Clinton scored 67 percent approval in late December 1992 and 61 percent approved of George W. Bush's transition in poll figures from January 2001, CNN said.

Forty percent of respondents told the Washington Post-ABC survey they have a favorable impression of the incoming president, compared with 54 percent who said they have an unfavorable impression.

That makes Trump the most unpopular incoming president since at least Jimmy Carter in 1977, the Washington Post said.

Forty-four percent said Trump is qualified to serve as president, as opposed to 52 percent who said he's not qualified, the Washington Post-ABC poll said.

When asked how much confidence they have that Trump will make the right decisions for the country's future, 38 percent said they had a great deal or a good amount of confidence. Sixty-one percent said they had just some or no confidence.

The CNN/ORC poll has a margin of error of plus or minus three percentage points. The Washington Post-ABC poll has a margin of error of 3.5 percentage points.

JUSTIN PIERRE JAMES TRUDEAU (CANADA)

CBC News, 16 January 2017:

Justin Trudeau and his Liberal government continue to enjoy strong support as the prime minister makes stops in Nova Scotia and New Brunswick on his cross-country tour Monday and Tuesday.

A poll released Monday by Corporate Research Associates of Halifax suggests 73 per cent of residents in Atlantic Canada are satisfied with the performance of the federal government, which is one percentage point lower than in August 2016.

The proportion of those polled who were dissatisfied with the performance of Trudeau's government was unchanged at 20 per cent. Six per cent of those questioned did not offer an opinion and one per cent said it is too soon to decide how the government is performing.

Trudeau's personal popularity stood at 62 per cent, which is down three percentage points from August.

THERESA MARY MAY (UNITED KINGDOM)

Sky News, 13 January 2017:

Theresa May has enjoyed the longest opinion poll 'honeymoon' of any Conservative prime minister since the 1950s.

May's premiership reaches the six-month mark on Friday, during which time her party has opened up an average poll lead over Labour of 14 points.

No Tory government in modern times has been in such a commanding position at this stage of a prime minister's time in office.

But pollsters have warned that the party's performance is more a reflection of Labour weakness than Tory strength, and could crumble if Brexit negotiations run into difficulty.

The Press Association has analysed the poll ratings for every government of the past 60 years precisely six months into the term of a new prime minister.

Only one government of any political colour has beaten May's current rating: the Labour administration led by Tony Blair, which had a colossal 29-point lead in the polls six months after Mr Blair took office in 1997.

By contrast, Margaret Thatcher's government was an average of five points behind in the polls, while John Major was six points down.

The Tories were one point ahead of Labour when David Cameron reached the six- month mark.

VLADIMIR VLADIMIROVICH PUTIN (RUSSIA)

Sputnik News, 22 December 2016:

More than 60 percent of Russians trust President Putin, with the level of confidence in the president increasing over the last months, a trust rating published by the Russian Public Opinion Research Center (VCIOM) showed on Thursday.
According to the poll, Putin's actions as the Russian president are supported by 85.8 percent of Russians…

The all-Russian opinion poll was conducted by VCIOM on December 17-18, 2016, in 130 cities around the country among 1600 people. The maximum margin of error is no higher than 3.5 percent.

SIMON WILLIAM "BILL" ENGLISH (NEW ZEALAND)

TVNZ News Now, 21 December 2016:

Support for National fell to 45 per cent at the start of December, but it's not clear if the party's leadership change had anything to do with the latest poll.

The Roy Morgan poll shows support for a Labour/Green alliance is up to 43 per cent and an election held now would have a close result, as a result of National's 4.5 per cent fall.

The poll was carried out between November 28 and December 11, covering the week before former Prime Minister John Key's shock resignation and the following week which saw Jonathan Coleman and Judith Collins contest Mr Key's eventual successor Bill English for the leadership.

SHINZO ABE (JAPAN)

The Japan Times, 18 December 2016:

The support rate for Prime Minister Shinzo Abe's Cabinet has tumbled to 54.8 percent from the previous month, according to a two-day nationwide poll, with over half of the respondents viewing the outcome of last week's Japan-Russia summit negatively, along with the unpopular legalization of casinos.

The Cabinet's approval rating compared with 60.7 percent in November, while its disapproval rating rose to 34.1 percent, up 3.7 points.

In the survey, conducted through Sunday by Kyodo News, 54.3 percent had a negative view of the summit between Prime Minister Shinzo Abe and Russian President Vladimir Putin held Thursday and Friday in Japan.

Questioned about the Diet's legalization of casinos the same week, 69.6 percent opposed the law and 24.6 percent supported it.

The same survey, meanwhile, showed 75.3 percent said they would not want a so-called integrated casino resort to be built in their neighborhood and 21.9 percent said they would support one.

Kyodo conducted the poll on 1,456 randomly selected households and received 1,018 valid responses.

JOKO WIDODO (INDONESIA)

The Sydney Morning Herald, 5 November 2016:

In contrast, Jokowi engineered a comeback. His approval rating stands at between 60 and 70 per cent in the various polls, close to his honeymoon highs.

And he has transformed a feeble grip on the parliament into a dominant one. His ruling coalition now enjoys 70 per cent of the seats in parliament.

How some people started off 2017

American actor Charlie Sheen commenced 2017 with this tweet under his belt:

Dear God;

Trump next, please!
Trump next, please!
Trump next, please!
Trump next, please!
Trump next, please!
Trump next, please!



©

— Charlie Sheen (@charliesheen) December 29, 2016

Saying what half the world's leaders are probably privately hoping.

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Chair of the Northern NSW Local Health District Board, Hon. Dr Brian Patrick Victor PEZZUTTI, R.F.D., M.B.B.S.(Syd.), F.F.A.R.A.C.S., F.A.N.Z.C.A. is apparently starting off 2017 by contesting a penalty notice he received:

Image via that avid court watcher Clarrie Rivers

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Liberal Democrat Senator for NSW David Ean Leyonhjelm entered 2017 at war with the South Australia Government and a particular News Corp journalist apparently because of unflattering media coverage:

"If the South Australia Government was a person, it would be an obese 40-year-old man with awful body odour who lives with his mother, refuses to work, and plays Xbox all day," Senator Leyonhjelm told Parliament on Wednesday. He pauses only to demand more Cheezels and iced coffee, or to complain when the lights go out."

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Be warned @ToryShepherd - you're open season. A photo of you even scratching your balls will go viral. https://t.co/RqSTPjc9PU

— David Leyonhjelm (@DavidLeyonhjelm) December 29, 2016

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Twice-elected U.S. President Barack Hussein Obama started 2017 with only 19 days left in office but with an obvious determination to go out with a bang:

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One Nation Senator for Queensland Malcolm Ieuan Roberts is determined to carry on with his unbalanced United Nations bashing. WARNING his link s to known false news website:

USEXIT (pronounced: you-sex-it) is now on the cards https://t.co/Za3FgfLcAu pic.twitter.com/8dGzy6JsD9

— Sen. Malcolm Roberts (@SenatorMRoberts) December 28, 2016

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The Turnbull Government came into the new year with yet another broken funding promise hanging around its neck:

ANTHONY ALBANESE: Whilst the Government has been proclaiming that it has record expenditure on infrastructure of $50 billion, the actual figure out to 2019 is $34 billion, with $8 billion into the never-never…..

JULIA HOLMAN: And Marion Terrill says that the most efficient way to boost productivity through infrastructure is to invest it in the cities.
But she says that the Government is choosing to spend significant amounts of money in regional areas and isn't focusing enough on the cities where most Australians live and work.
MARION TERRILL: Well I have found evidence of the politicised decision making for sure. You know it's hard to know what is exactly their motivation but certainly there is electoral advantage to them in spending in areas that are not particularly important to the economy, and they do do that. 

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Il Papa has some explaining to do this year after his annual Christmas revels did the rounds on Twitter:

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