The role of home carers: findings from a study of alcohol and older people.

The main aim of this study was to assess the current and potential role of home carers in the identification and response to problems associated with alcohol use and misuse in older people. The study was carried out in three local authority areas in London. A combination of qualitative and quantitative methods was used, but this article will mainly draw on the qualitative data. The research showed that home carers reported an increasing caseload of clients with dementia and confusional states, which are problems that often mask alcohol misuse. Home carers tended to view alcohol use as either 'alcoholic' (and therefore a problem) or nonproblematic, and relied on overt signs (e.g. self-neglect, aggressive behaviour) to identify alcohol misuse. The key factors mentioned by carers as associated with alcohol misuse were loss (of relationships, status, health), loneliness and isolation, and depression. When alcohol misuse was identified, the concern was to 'contain' the client rather than address the alcohol problem or its underlying causes. The findings suggest that home carers are well placed both to identify and to respond to problematic alcohol use by clients, but they face a number of 'barriers' to developing this aspect of their work, such as the lack of clear practice guidelines, the lack of training and inadequate support structures. Suggestions are made concerning how alcohol issues could be incorporated into current practice guidelines and training.