Home' Australian Pharmacist : Australian Pharmacist April 2013 Contents 38 Australian Pharmacist April 2013 I ©Pharmaceutical Society of Australia Ltd.
This view was backed by Karim Dar in
the report Alcohol use disorders in elderly
people: fact or fiction? in which he stated:
'The number of older people is increasing
in populations throughout the world.
Alcohol use disorders in elderly people
are a common but underrecognised
problem associated with major physical
and psychological health problems.
'Owing to the negative attitudes and
inadequate training of healthcare
professionals, alcohol misuse is not always
being detected or effectively treated.
Current diagnostic criteria and common
screening instruments for alcohol use
disorders may not be appropriate for
'Older people are as likely to benefit
from treatment as younger people and
the basic principles of treatment are
much the same. Better integrated and
outreach services are needed. Training of
healthcare professionals in this area and
pragmatic research should be prioritised
to improve detection, treatment and
service provision for this vulnerable and
Pharmacists have a unique opportunity
as frontline health professionals to detect
and help those with alcohol issues and
one area of particular value is Home
Medicines Reviews. A Home Medicines
Review offers an ideal opportunity to ask
about alcohol consumption and to assess
the number of standard drinks that the
person is consuming.
The accredited pharmacist can also
provide education about safe drinking
levels, the effects of alcohol and
interactions with medications. As with
other lifestyle risks, pharmacists can assist
behavioural change with motivational
Grant Martin, Chief Executive Officer of
the Australian Association of Consultant
Pharmacy, said HMRs done in a person's
home gave the pharmacist doing the
review more opportunity to assess the
surroundings which may enable them to
observe factors indicating issues such as
'Having a one-on-one relationship in the
safe environment of a person's home
gives the pharmacist the opportunity to
assess and ask questions which may help
Among the resources available to help
pharmacists is the PSA online module
on Motivational Interviewing which
includes behaviour change theory and
stages of change model. The module
is available on the PSA website: www.
PSA Self Care Fact Card: Alcohol.
Resources such as those available at:
www.alcohol.gov.au can be useful to
take to home medicines reviews and
have available in pharmacies. Other
useful resources can be found at the
reveal problems or potential problems,'
Mr Martin said.
'The principle behind the HMR is that the
in-home review does allow much more
careful observation and assessment of the
patient in their environment.'
James Pitts, Chief Executive Officer of
Odyssey House McGrath Foundation
which deals with alcohol addiction, drug
and prescription medication dependence
and co-existing mental health conditions,
said some health professionals certainly
didn't pick up signs of alcoholism which
may be put down to ageing.
'Pharmacists should engage in conversation
with the patients, and the signs may vary
from person to person. With the elderly,
increased anxiety may be something to look
for and people who are alcohol dependent
may show greater signs of anxiety as they
grow older. But as people get older there
are certainly symptoms that appear that
can be due to ageing or alcoholism --
forgetfulness being an example.' he said.
'I think pharmacists should try to engage
the older patients and ask questions if
things seem to be as they should not
be. One of the things of course that you
don't want people to do is mix alcohol
and medications, particularly if those
medications are acting directly on the
central nervous system.'
But Mr Pitts said one of the factors to be
taken into account was the workload of
health professionals, particularly GPs.
'They are so pressed for time that they don't
have the time to concentrate on problems
which may be associated with drug use --
whether licit or illicit,' he said.
'It also depends on the information health
professionals get from their patients.
A recent survey showed that 30% of those
surveyed believed they knew someone
with an alcohol problem but that those
people themselves didn't realise they had
This view was backed by Michael O'Neill
from National Seniors Australia when
he said: 'Sometimes the excessive use of
alcohol can be misdiagnosed as a normal
consequence of ageing.'
Mr O'Neil said time was an
'I am cautious about advising pharmacist of
what to do. It's taking the time with people
-- this is first and foremost,' he said.
'Using the professional skills and knowledge
which pharmacists so clearly have can
provide that guidance and advice in terms
of perhaps advising an older person who
they think may have an issue to see a
doctor. The pharmacist needs to take the
time to talk to the older patient.
'But also the pharmacist can light the
fire in terms of planting the thought that
there may be a bit of an issue here and so
the older person needs to take the first
step. The first step is often one around
acknowledging that there is an issue,
and the second step is acting upon it.'
'Pharmacists have a
as frontline health
professionals to detect
and help those with
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