Collaborative care for alcohol-related liver disease.

By implementing collaborative care for patients with alcohol misuse and alcohol-related liver disease, the Royal Bolton Hospital aimed to improve and coordinate their care by recruiting a multidisciplinary team and placing the patient at the centre of all efforts. There has been a marked improvement in the accuracy of the drinking histories taken, detoxification, dietary documentation, and patient and staff attitudes and confidence, with enhanced satisfaction in patients, their families and staff and improved accessibility and communication. We observed a considerable increase in the number of inpatient and outpatient referrals and believe that it is more effective to work together in a joint gastroenterology/psychiatry team. There is a critical national need to establish steering groups of key clinical, managerial and commissioning personnel to address the growing problem of alcohol misuse. The appointment of dedicated alcohol health workers is central to this strategy.

Alcohol misuse in older people: heavy consumption and protean presentations.

BACKGROUND: Alcohol misuse, especially binge drinking in young people, and alcoholic liver disease are major public health concerns. However, alcohol misuse in older people is underestimated and often goes undetected. OBJECTIVE: To document alcohol consumption and clinical presentation of alcohol misuse in hospital inpatients aged >or=60 years. METHODS: 208 inpatients aged >or=60 years, referred to the alcohol liaison nurse between 1998 and 2003 at the Royal Bolton Hospital, Bolton, UK, were assessed for sex, alcohol intake, primary and secondary reasons for admission, and other concurrent health problems and death. RESULTS: 90% of men drank >21 units weekly and 93% of women drank >14 units weekly. Median weekly alcohol intake was 78.5 units for men and 47 units for women. Acute intoxication, falls, circulatory problems and alcoholic liver disease were the main primary reasons for admission. Neglect or malnutrition, alcoholic liver disease and hypertension were the main secondary reasons and concurrent health problems. 30% of patients died between 1998 and 2003. CONCLUSION: In inpatients aged >or=60 years who were referred to the alcohol liaison nurse in a district general hospital, heavy alcohol consumption, often to very high levels, was characteristic in both men and women and was associated with a wide variety of primary and secondary clinical presentations, including death.