1.0 Introduction
Kaumatua (older adult) identifies as the demographics age of 65 years and older (Santrock, 2014). Currently, there are around 600,000 adults aged 65 years and older living in New Zealand. In the next ten years, there will be close to one million (Hodges, 2014a). New Zealand has the second highest portion of seniors that consume alcohol being 83 percent. Alcohol addiction was once construed as a youth to an adult problem. However, research integrates that up to 40 percent of older adults of 65 and older are being categorised as hazardous drinkers that could potentially cause hazardous consequence (Hodges, 2014b). It is estimated that 800 people in New Zealand will die each year from alcohol-related causes (Conner et al, 2013). Mental illness affects 582,000 adults in New Zealand and are diagnosed with a common mental health disorder at some stage of their lives. Anxiety and depression disorder are the seconded leading cause of health decline in the older adult in New Zealanders and is predicted to become a major concern by 2020 (Mental Health Foundation of New Zealand, 2014).
The most common mental and neurological disorders in this age group is dementia, depression, and anxiety. People who abuse alcohol are more likely to suffer from major depression or alcohol induced dementia (Ministry of Health, 2017a). Overall, alcohol is the fundamental substance abused in the older adults and often coincides with mental health disorders and is frequently overlooked or misdiagnosed, or there is an unwillingness to diagnose individuals because they are seen as old (Bogunovic, 2012). Older adult’s problem drinking in New Zealand tend to be classified as either, early onset or late onset drinkers (Health Promotion Agency, 2017b).
This report will discuss the holistic nature of a co-existing mental health problem, using Te Wheke, the Maori health model. The report will analyse the effects of alcohol use in the Kaumatua (older adult) and identify effective strategies with interventions that can be installed to mediate the consequences of individuals and their Whanau/Family, Iwi and communities within New Zealand.
2.0 Definition of Co-existing problems
Mental health and substance abuse often coincide. The relationship of alcohol abuse is somewhat complicated as problem drinking can cause mental health conditions and, conversely, a mental health condition may cause problematic drinking. The two factors lead to substance and mental health problems occurring. Alcohol is strongly associated with social phobias, anxiety, depression, and dementia in the older adult in New Zealand. Alcohol addiction has a vast impact on one’s physical being. Alcohol abuse can contribute to health problems such as cancers, cardiovascular disease diabetes and self-harm due to falls. One of the biggest risked with alcohol in the older adult is mixing their prescribed medications and alcohol (Alcohol Rehab, 2018).
3.0 Critically examine the holistic nature of co-existing problems using the Te Wheke Framework
The Maori health model designed by Dr. Rangimarie Turuki Rose Pere. The octopus and its eight tentacles represent the link between the holistic nature of the individual and whanau health, each tentacle focuses on a pacific health dimension (Ministry of Health, 2017b).
3.1 Hinengaro – The mind
Conditions such as depression, anxiety, suicide and substance misuse, delirium, dementia, and schizophrenia all fall in the contexed of mental health disorders in the older adult, but do not occur due to aging. Depression is one of the most commonly studied mental illnesses of the elderly. Depression in the elderly is believed to be associated with vascular brain changes. People with depression experience low mood and a loss of interest or pleasure, feeling extreme sadness or guilt and low self-worth, sleep disturbance and low appetite, low energy, and poor cognition. Diagnosing depression in the elderly population can be compounded by the difficulty of differentiating it clinically from dementia as dementia both present with impaired cognition fatigue, sleep disturbance and as mentioned above (Evans, Nizette, & O Brien, 2013).
3.2 Mauri – Life force in people and objects
Older adults that experience mental illness, feel that it is a private issue and are hesitant in sharing their experiences with others as they will burden their family with their depression and anxiety problems. The older adult often ignores symptoms for a long time and only seek medical help when they reach crisis point. When they are unable to concentrate and withdraw from social or whanau, they can become lethargic and no longer enjoy aspects of life they once did (Health Promotion Agency, 2018a).
3.3 Taha Whanau – Social
The reasons older adults’ social dimension is affected is related to pre-existing problems such as drinking alcohol and their bodies reduced ability to metabolise alcohol due to the normal aging process, poor sleep quality and reduced nutritional intake. Life events such as death of friends or loved ones, retirement, poverty, adverse reaction to polypharmacy, loneliness, chronic illness, disease or the feeling helpless or worthless, losing independence through illness or loss of mobility and that they are burdens to their families all contribute to social breakdown (Health Promotion Agency, 2018b).
3.4 Taha Tinana – Physical Wellbeing
Physical health is entwined closely with mental health. The mind and body are one. People with mental health disorder, subsequently this can impact their physical health and vice versa. When an older adult suffers from depression, they have a higher risk of cardiovascular disease, osteoporosis, diabetes, stroke, and Alzheimer’s disease and if they have any of the above condition, they at higher risk of developing depression. Older adults also experience a decline in their physical capabilities reduced mobility chronic pain/illness and can have many comorbidities that can potentially affect the mental health and intern affect their ability to maintain their physical wellbeing. (WHO, 2019). Furthermore, a contributing factor is substance abuse. Alcohol consumption in excess has a negative effect on short- and long-term health, one of which affects to the brain that can lead to Alzheimer’s disease or alcohol-related brain damage, dementia (ARBD). This is defined as long term memory and thinking decline due to damaged nerve cells shrinking of brain tissue and is also related to the deficiency of thiamine this affect the way your body stores nutrients (Alzheimer’s Society, 2019).
3.4 Whanaungatanga – Extended Family
Elderly people that are more socially connected with family and friends or involved in their community are happier, and are physically healthier and live longer with fewer mental health problems than people that are disconnected or isolated. Most elderly have spent many years bring up family’s, socialising and working and have found stability. However, elderly people are vulnerable to loneliness and social isolation this can be detrimental to the physical and psychological health. This can occur due to retirement, bereavement, family, and friends moving away or losing physical capabilities to mobilise, or due not being unable to drive (Mental Health Foundation, 2019).
3.5 Wairuatanga – Spirituality
Many aged adults find spirituality and religion an important part of their identity and a strong predictor of quality of life, some ethnicities believe that mental illness is placed upon them, due to sins that they committed in their lifetime (Victoria State Government, 2018)
3.6 Whatumanawa – Emotional
Aging can bring many different emotional challenges. Loneliness is a normal phycological process that elderly people may experience and has been linked to early motility. Depression can present as server sadness, disconnection, and emotional torment. Being depressed can leave an individual feeling worthless, hopeless, many age adults see themselves as a burden to the family (National Institute of Health, 2015).
4.0 Effects of Alcohol on Individual
Hazardous and harmful alcohol consumption affects more men than women in New Zealand. Older adults are less tolerant to the effects of alcohol as the body ages, alcohol is not metabolised by the body effectively as the body muscle mass reduces also intracellular fluid and adipose tissue. This means alcohol will have a faster effect on the brain and nervous system. Alcohol is a nervous system depressant and a psychoactive drug that enters the stomach and absorbed by the bloodstream and then metabolised in the liver by an enzyme called alcohol dehydrogenase (Health Promotion Agency, 2018). Alcohol contains ethanol or ethyl these are carcinogen that will affect every aspect of the body it will even provide a false sense of security to those that suffer from anxiety or depression, loneliness and can lead to individuals developing a dependency or addiction. If alcohol is used frequently it can cause depression as it lowers the level of serotonin being released. Alcohol also increases the risk of falls and injury, and developing cancer of the throat, oesophageal, intestines, liver and breast (CDC, 2018). It also affects eyes, nutrition, bones and muscle, coordination, cognitive function, brain tissue, nervous system and cardiovascular system (Lewis, 2016).
4.1 Alcohol and Family
When individuals have an alcohol addiction it can have a marked effect on other family members. It is not easy to live with a person with addiction as they are often full of conflict and torn between their addiction and not wanting the harm that follows. They often blame others when things go wrong and can become aggressive especially if there is hostility towards one another. Spouses and family often feel hurt and ashamed, fearful, and have a sense of failure that they are unable to make changes or their help is not received gratefully. Research shows that families affected by alcoholism are likely to have low levels of emotional bonding and excessiveness and independence. Furthermore, the older adult can become more socially isolated and experience financial hardship and are more susceptible to mental illness (American addiction centre, 2019).
4.3 Alcohol and Community
Fourteen percent of New Zealand’s population is predicted to meet the criteria for substance use disorder at some point in their life. Approximately, 23,000 people receive treatment in the publicly funded health system each year for alcohol or drug addictions in New Zealand. Between 18 -35 percent of New Zealand injury-based emergency department presentation are related to alcohol and this raises in the weekend 60 -70 percent. Alcohol misuse resulting in harm can be considerable costing between 1.5 – 2.4 billion in New Zealand. Over 100 drinking and driving offensives and arrest for intoxication and disorderly behaver, although the number of elderly people is low, it is still prevalent. Older adults who drink alcohol are at a greater risk of traffic accidents and falls. Alcohol also has an adverse effect on many commonly prescribed medications Approximately 45 percent of fire fatalities each year involve alcohol (Health Promotion Agency, 2017). New Zealand offer services for mental health and addictions that can be accessed via individuals or referrals to alcohol drug line, alcoholic anonymous or Arc Counselling services.
4.4 Alcohol – Iwi
In New Zealand, it is not uncommon to have alcohol at family gatherings as it is a part of New Zealand’s culture. Many New Zealander associate alcohol with having a good time socialising. It is also consumed in times of sorrow. In 2017 to 2018, 476 million litres of alcohol were consumed (Stats New Zealand, 2017). Alcohol in the older adult is a growing concern for New Zealand and as stated above it is associated with violence, injury, and poor health outcomes physically and mentally. Eighty percent of Maori in New Zealand drank alcohol in the past year. Forty-eight percent of Maori males and thirty-six percent female had a potentially hazardous drinking pattern (Health Promotion agency, 2018). The figure reveals the consumption of alcohol within Maori culture is still a concern. Kaumatua and whanau are held in high regard in the Maori culture, Iwi will hold huis and implement support services for their people that suffers from addiction (Drug Foundation, 2015).
5.0 Supportive Health Strategies
A strategy is a document that outlines the vision for the future and how it will be implemented to assisted people of New Zealand by improving or maintaining their health (Ministry of Health, 2019).
5.1 Healthy Aging Strategy
Healthy aging strategy. (2016) This strategy is closely aligned with the wider New Zealand health strategy and also has strong links with the positive aging strategy. The five New Zealand Health strategy’s that are implemented in the healthy aging strategy’s actions. Are, people-powered, closer to home, value and high performance, one team, and a smart system. The priority of the strategy is to improve the quality they live their life with a strong focus on prevention, wellness, and support for independence, and incorporating family/Whanau and community. It gives priority to equity and support to the most vulnerable including final stages of life. It encourages communication with all services in the health profession.
The strategy recognises people age in different ways and that our population is diverse and the way older adults’ access and interact with services especially individuals affected with long term illnesses, complex needs and elderly population groups that experience poorer outcomes in New Zealand’s health system. It also looks at the need to meet the health needs and support of our increasing the ethnically diverse population. The strategy wants to ensure that people that work with older adults have adequate training and that services are available to the elderly population such as oral health, early detection of mental health, elderly with CEP have access to community mental health service with a reduced stigma attached (Healthy Aging Strategy, 2016).
The intervention is the implementation of the twenty-seven action, over the next ten years, this will provide a plan and will assist in the responsibility for improving living and the health of the older adult, as it will assist health professionals and services to implement adequate care that is suitable for our aging population (Healthy Aging Strategy, 2016).
5.2 Te Ariari o te oranga Framework
The framework, Te Ariari o te oranga. The Assessment and Management of people with Co-existing Mental Health and Substance abuse problems, (2010). The framework provides knowledge and skills to health care professionals working with CEP clients and enables health care workers to effectively respond to the client’s needs and their family’s/whanau. This also provides clinical guidance to services and health professionals. It allows relationships to build between services and staff as communication between services is proven to be fundamental to the success of the treatment CEP. There are seven key principles to the framework, wellbeing, cultural considerations, engagement, motivation, assessments of management and integrating care. The framework has five phases of treatment, Pre-treatment, early treatment, middle treatment, late treatment, and autonomous treatment. The principles can be implemented by health care professionals’ practice at each phase of care for the client. The framework has a holistic approach that incorporates Whanau, as it is recognised that whanau is the foundation of the Maori society and is the principal source of strong support, security, and identity (Todd, 2010). Te Ariari o te Oranga addresses the challenge with engaging with clients with CEP. The intervention is to establish engagement with the client and aims to reduce gaps and barriers between services. The intervention established was to aid health professional to implement the seven principles was Te Whare o Tiki, co-existing problems knowledge and skills framework, this enabled health professionals to know the level of knowledge and skill they will require when working with clients that suffer from CEP and their Whanau and assessment tools for them to assess their level of knowledge (Matua Raki & Te Pou, 2013).
5.3 Internal Strategy to Minimise Alcohol-Related Harm
Internal Strategy to Minimise Alcohol-Related Harm, (2016). This strategy is an adapted, updated version of Alcohol Harm reduction strategy of 2012. The strategy was developed with the aim to make Auckland a safer and healthier city with reduced risk of alcohol-related harm within their community. It discusses the Auckland council wide-ranging role in actively minimising alcohol-related harm that illustrates a long term vision and desired outcomes and discusses consistencies of the minimalization of alcohol and alcohol-related harm, the strategies implements licensing and compliance, policy and bylaws and will use New Zealand’s statistics to gauge the success of the strategy by assessing emergency admissions due to alcohol, reduction of alcohol-related motor vehicle accidence.
The vision is to work in a coordinated approach with governmental legislation and departments such as New Zealand police, health, and education as well as non- government agencies and the alcohol sector of the Auckland Council. With regularly monitor and inspections of licensed premises for compliance of sale and supply of alcohol that adheres to the Alcohol Act 2012. This will aid in the reduction of hazardous alcohol consumption and potentially reduce community alcohol-related harm (Auckland Council, 2017).
6.0 Evaluation of strategy’s
6.1 Evaluation of Healthy aging strategy
The writer believes this strategy actions will vastly improve the older adult population health with early detection of CEP and other care needs and that services are being made more available to the elderly of New Zealand. The writer believes that it is up to health care professionals to install these actions for the older adult and to recognise that the older adults have different needs at different times. By implementing partnership, participation and protection while working in the health industry and ensuring professional obligations are met, will ensure the success of the strategy. The strategy was aimed at the older adult growing population but was not specifically aimed at reducing alcohol or mental health but had valuable areas of improving long term conditions that will, in turn, reduce adverse effects of long-term illness. The writer believes will successfully improve and prevent mental health problems.
6.2 Evaluation of Te Ariari o te oranga
The writer believes the intervention is a valuable tool to health care professionals, as it provides knowledge and a self-assessment for their existing knowledge on CEP. This will benefit them and the individuals with CEP and their Whanau. It will identify if there is a need for improvement. As a section of the framework disclosed there are limitations in health care professional knowledge when it comes to working with people with CEP. Although the framework did not identify a pacific age group and focused on the general public a section did identify Maori and their kaumatua and other cultures. The writer believes that the early intervention and engagement is an important part of working with people with CEP and then you can establish motivational interviewing once the individual is engaged.
6.3 Evaluation of Internal Strategy to Minimise Alcohol-Related Harm.
This strategy was not specifically aimed at older adult with CEP but focuses on reducing hazardous drinking in Auckland’s CBD and surrounding communities. The aim is to reduce the harm caused by excessive unsafe drinking. The writer believes that this will reduce the number of vehicle accidents, crime and falls that are associated with hazardous drinking for all age groups and will benefit the elderly. Another positive is the strategy is working alongside New Zealand police and other community associations. With the focus to improve high alcohol risk populations by using education and promoting low-risk drinking advice to the public and provide more alcohol-free advents for communities. The writer believes this may improve New Zealand drinking culture.
6.0 Conclusion
To conclude, this report has provided some statistics in relation to depression and alcohol misuse. Then goes on to discuss the connection between co-existing and mental health problems and the affect the substance alcohol in the older adult. The report discusses the holistic effects of mental health using the Te Wheke model, the report also discusses the effects of alcohol to an individual, the family, community, and Iwi. The report identified three health care strategies and discussed how they could benefit and assist the individual older adult and their family and the wider community to improve their health outcomes mentally and physically.
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