Public Service Review: UK Science and Technology - Issue 3
PROFILE- Alcohol use in later life
19 October 2011
Excessive alcohol consumption is a term that includes both harmful and hazardous amounts. Harmful consumption is drinking that poses a risk to physical or mental health, while damage is already present in hazardous consumption. Rises in the rates of both harmful and hazardous alcohol consumption have been well documented in the academic press; however, researchers have tended to focus their attention on excessive drinking in young people. This is mirrored in media reports on the subject and the needs of older people have received little attention in alcohol policies, meaning that their problems associated with excessive drinking are often unreported.
Definitions of the current recommendations for alcohol consumption are: up to 4 units/day for men and 3 units/day for women, or 21 units/week for men and 14 units/week for women.
There is little consensus on the age at which people are deemed to be 'old' or 'older' or when later life begins. Research into later life adopts a range of ages from 50 onwards, and whilst for some this may appear very young, in some disadvantaged communities some people experience the problems associated with older age at 50.
Excessive drinking is known to be harmful to health: it can make pre-existing conditions such as diabetes, high blood pressure and ulcers worse, and increases the risk of alcoholic liver disease. All of these are more commonly experienced in middle and later life. Even moderate consumption of alcohol can increase the risk of falls, especially when mixed with some prescription medications. Indeed, the combination of medication and alcohol can pose serious risks to health, and the average person aged over 65 takes at least two medications per day.
In moderation, alcohol can also be beneficial to health by lowering the risk of dementia and stroke and in offering some protection against heart and respiratory disease, so the picture is complex.
The extent of the problem
General population data, such as that from the General Household Survey, indicate that overall alcohol consumption amongst the British population decreases with age. Other evidence shows this, but that over 55s in Britain are more likely to be regular drinkers than their European counterparts. Furthermore, up to 15% of men and 7% of women aged 65 and over, and 23% of men and 8% of women aged 60 and over drink more than the recommended weekly limits. Older women appear to be at particular risk of increasing their alcohol consumption as they get older because they are more likely to experience loss, eg bereavement and loss of good health, leading to depression and loneliness. Whilst for some the risk of developing harmful patterns of alcohol consumption increases with age, most appear to carry drinking patterns set in their younger days through to older age, so each generation may have different patterns of drinking.
Little is known about the extent of excessive drinking in older age groups or its impact on drinkers or their families. However, studies that have tested the effectiveness of interventions to treat excessive drinking show that older people are at least as likely to benefit as young people, and that they are more likely to follow the regimens if offered to them. Unfortunately, they are also less likely to be referred for specialist help and support.
How far older people's needs are met
In 2009/10, with funding from Age UK, researchers from Sunderland and Newcastle Universities carried out an assessment of the needs of older people in relation to alcohol across South of Tyne and Wear, an area covering Sunderland, South Tyneside and Gateshead. This is an area with a higher-than-average older population and one with high levels of social and economic disadvantage. It is also an area with a strong industrial past and pockets of heavy drinking.
The needs assessment was carried out in two phases. The first phase looked at the views and experiences of older people aged between 51 and 90 years who drank at all levels of risk (low to dependent), and the second mapped the services available to support older drinkers. The focus of the study was on people aged over 50 in line with the age group supported by Age UK.
Participants identifying their drinking as low-risk associated alcohol with sociability, relaxation and forgetting troubles. Among participants who identified problems with their drinking, many had other health problems, in particular mental health problems. They were likely to drink at home and in isolation from others. Many kept their drinking hidden because of the shame they felt. Many felt that it was too late to change. If they sought help it was most likely to be from their GP, but many felt stigmatised and had concerns that there were few services available for them to access for support. Issues such as bereavement and lack of meaningful activity, which were more common as they aged, were reported as triggering and increasing their alcohol intake, but by and large their excessive drinking had started earlier in their lives and had carried on into old age.
Of 47 providers of services included in the mapping, only one reported that they specifically catered for the needs of older drinkers. Most provided services that were intended to be accessed by people of any age over 18. Nonetheless, most of their promotional material was geared towards young people, and alcohol services specifically for younger people were provided.
An ageing population means that the absolute number of older people with alcohol problems is inevitably on the increase and we need get to grips with the problem now. This means that the need to establish an understanding for the problems faced by older drinkers has now become urgent.
More information is needed to understand patterns of drinking in later life and to establish the extent, nature and impact of hazardous drinking amongst older age groups. Further research is required to identify and test out targeted interventions to improve the health of older drinkers.
Commissioners of services must start to consider the needs of older drinkers in their commissioning decisions. Older people drinking hazardously may not consider themselves at risk and be reluctant to reduce their drinking if still enjoying functional health. Drug and alcohol services need to be more sensitive to the needs of older people and to consider how they can engage more effectively with this age group. Services that cater for the needs of older people should consider the possibility that older people may be drinking heavily to alleviate pain, boredom and isolation, but that this can have a negative impact on the management of many of the long-term conditions that are more common in later life. They also need to consider how they can prevent problems escalating at times of stress or loss, such as bereavement or the onset of chronic or life-limiting illnesses.
The report for the study outlined is available from Age UK, and the Fuse team in collaboration with Age UK have developed a brief for commissioners, available from September 2011.
Dr Katie Lock, Newcastle University
Dr Graeme Wilson, Newcastle University
Dr Jonathan Ling, University of Sunderland
Karen Smith, University of Sunderland
Professor Eileen Kaner, Newcastle University