Community Based Care for Older People with Alcohol-Related Harm : Findings from a consultation workshop with practitioners in social work and social

This report emerged from an interactive workshop on identifying and responding to alcohol issues in non-clinical settings funded by Alcohol Research UK (Grant Reference No: R/2013/06). Little is known about the daily challenges faced by the social care workforce when an older person is living at home with issues associated with problematic alcohol use. The situation can be very complex and challenging for those offering support particularly where there are co-existing physical health conditions and mental ill-health. The workshop was attended by 37 participants from: domiciliary care (2) voluntary sector employees (2); social workers with older people (23); mental health practitioners (5); specialist workers in alcohol and drugs (2); community nurses (2); manager of quality (1). Participants came from London and outer regions and were recruited through outreach to the university’s existing local partnerships and networks. The workshop facilitated themed discussion areas which aimed to: a) explore and describe current issues for the community-based workforce working with older people with alcohol related harm in order to identify training and support needs b) make recommendations derived from participants practice experience which better identify and provide support community based care for older people and to inform the range and types of collaborations and care pathways needed for improvement. c) explore the potential for using visual imagery as a method to convey information about the issues in an accessible format. Key findings 1. Improved infrastructure and referral pathways are needed to ensure a more holistic approach towards older people with problematic substance use. Basing specialist workers in social work teams and regular liaison between social work and other community services such as health, housing and ageing or carers’ services would establish and develop trust and support frequent communication. 2. Develop tailored and sensitive tools that facilitate screening and assessment which are friendly to use across a range of services to help detect co-occurring conditions in older people experiencing problematic alcohol use. There is a need for toolkits to facilitate ‘good practice’ approaches for use in training and by practitioners and service commissioners. 3. Mandatory education about harmful effects of alcohol in later life is needed to make sure everyone is prepared to assess, identify and work with older people with alcohol issues. This should target hospital staff, GPs as well as social services, care staff, not just on alcohol but more widely about how this interacts with other issues in later life such as health, mental health and polypharmacy. Service users and carers also need to be targeted with education. 4. Provide specialist training/information/skills on working with brain injuries and other mental health or cognitive impairment in older people as a result of sustained alcohol misuse. 5. All professionals have a responsibility for their own knowledge and skills and updating themselves on current issues and this should be discussed and encouraged during appraisals and reviews. 6. Policy, practice guidance and commissioning should recognise the importance of being able to build rapport and engage with older people. Practioners require sufficient allocation of time to do this and support to access any relevant resources to support care planning as a result of their assessments. 7. Meaningful engagement requires facilitating older people to access support that is specifically tailored for them; for example, by being delivered in their own homes or somewhere they can get to easily or in places they already might go to. 8. There is a need for more community-based resources that work with alcohol related issues including outreach and advocacy

Reformation of casein particles from alkaline-disrupted casein micelles

In this study, the properties of casein particles reformed from alkaline disrupted casein micelles were studied. For this purpose, micelles were disrupted completely by increasing milk pH to 10·0, and subsequently reformed by decreasing milk pH to 6·6. Reformed casein particles were smaller than native micelles and had a slightly lower zeta-potential. Levels of ionic and serum calcium, as well as rennet coagulation time did not differ between milk containing native micelles or reformed casein particles. Ethanol stability and heat stability, >pH7·0, were lower for reformed casein particles than native micelles. Differences in heat stability, ethanol stability and zeta-potential can be explained in terms of the influence of increased concentrations of sodium and chloride ions in milk containing reformed casein particles. Hence, these results indicate that, if performed in a controlled manner, casein particles with properties closely similar to those of native micelles can be reformed from alkaline disrupted casein micelle

Delivering alcohol IBA (identification and brief advice): broadening the base from health to non-health contexts.

Key findings: • There is sufficient evidence to support current optimism about the potential for alcohol IBA to be delivered in a range of health and non-health settings • Online IBA models have potential to reach individuals who may not access health or support services. • Organisational, professional and context- specific challenges impede implementation and, in particular, the sustainability of initiatives over the longer term • Training has an important role to play in improving the knowledge and skills level of staff; however, on its own, it does not guarantee delivery of IBA • Evaluation and monitoring should be built in to new initiatives to ensure appropriate use of resources and to promote a culture of learning from practice [The online resource (see URL link above] contains links to a number of relevant publications

The alcohol improvement programme: evaluation of an initiative to address alcohol-related health harm in England

Aims: The evaluation aimed to assess the impact of The Alcohol Improvement Programme (AIP). This was a UK Department of Health initiative (April 2008–March 2011) aiming to contribute to the reduction of alcohol-related harm as measured by a reduction in the rate of increase in alcohol-related hospital admissions (ARHAs). Methods: The evaluation (March 2010–September 2011) used a mix of qualitative and quantitative methods to assess the impact of the AIP on ARHAs, to describe and assess the process of implementation, and to identify elements of the programme which might serve as a ‘legacy’ for the future. Results: There was no evidence that the AIP had an impact on reducing the rise in the rate of ARHAs. The AIP was successfully delivered, increased the priority given to alcohol-related harm on local policy agendas and strengthened the infrastructure for the delivery of interventions. Conclusion: Although there was no measurable short-term impact on the rise in the rate of ARHAs, the AIP helped to set up a strategic response and a delivery infrastructure as a first, necessary step in working towards that goal. There are a number of valuable elements in the AIP which should be retained and repackaged to fit into new policy contexts