Generation drink

Julie BreslinA major new report sheds light on the alcohol habits of the over-50s. Are they risking drinking themselves into an early grave?

Last month the government revised its sensible drinking guidelines for the first time in 20 years, bringing the recommended weekly levels for men down to match those for women – at 14 units (see news story, page 4). One reason for the revised limits, says the government, is that the links between alcohol and cancer were ‘not fully understood’ when they were first issued in 1995.

Now a new report from the Drink Wise, Age Well programme, whose partners include the International Longevity Centre (ILC-UK) and treatment charity Addaction, highlights the fact that it may well be the over-50s who are most risking their health through their drinking habits. Drink wise, age well: alcohol use and the over 50s in the UK is the largest ever study of its kind, surveying nearly 17,000 people from across the country. It found a population whose problem drinking may well be ‘hidden in plain sight’.

Not only were age-related issues such as bereavement, retirement, loneliness, money worries and loss of a sense of purpose leading people to drink more in many cases, those people were also far less likely to seek help. Nearly 80 per cent of those identified as higher-risk drinkers drank ‘to take their mind of their problems’, says the report, with ‘not coping with stress’ the strongest predictor for being a higher-risk drinker.

A quarter of respondents had no idea where to look for support – and said they wouldn’t ask for help even if they did know – while more than 80 per cent of those identified as being at increased risk from their drinking had never been asked about it by a professional. More than half of over-65s also thought people ‘had themselves to blame’ for any alcohol problems.

Although most survey respondents were found to be lower risk drinkers, a ‘significant minority’ were not, says the document, and it’s a problem that’s likely to get worse. More than a third of the UK population is over 50, and by 2040 nearly one in four will be 65 or above, shoring up major problems if the ‘drinking patterns of older adults do not change’. Between 1991 and 2010, alcohol-related deaths among the 55-74 age group in England increased by 87 per cent for men and 53 per cent for women, meaning there is a ‘pressing need’ for action to reduce alcohol-related harm.

As the report points out, the image that harmful alcohol use tends to conjure up is one of young people binge drinking. Is the issue of older drinkers still largely a hidden one? ‘Very much so,’ head of the Drink Wise, Age Well programme, Julie Breslin, tells DDN. ‘Quite often drinking in later life takes place behind closed doors, and therefore is not as visible as young people’s drinking in a town or city centre of a Saturday night. Also our report shows a high level of stigma for older drinkers, so it’s quite possible that if there is an issue they won’t tell anyone.’

The report highlights the lack of a coherent plan to address alcohol-related harm in older drinkers, so what could be done at government level – should there be a national strategy? ‘From a starting point we’d like to see more consistent UK-wide collection of data on alcohol use and older adults,’ she says. ‘For example, PHE have only recently started collecting alcohol statistics on adults aged 75 and over, and in order to compare and assess the scale of the problem we’d like to see some consistency in the information gathered across the four nations. Secondly, we’d like to see alcohol and ageing on the agenda across a number of cross-care areas, such as dementia, retirement, social isolation. Alcohol use doesn’t happen in a vacuum.’

The programme is also advocating for the needs of older people to be specifically highlighted in existing government strategies, in order to raise the issue in professional and commissioning circles. ‘Up until now only the Wales and Northern Ireland alcohol strategies particularly reference the needs of older adults,’ says Breslin.

One of the major issues identified by the report is a widespread confusion and lack of awareness around units and guidelines. Will the recent revisions go some way to rectifying that or is there still a lot more to be done to get a clearer message across? ‘In our report nearly three quarters of respondents were unable to correctly identify recommended units,’ she says. ‘Hopefully the new guidelines are a good starting point and easier to digest. However for many people even the concept of “units” is difficult to grasp and we may need to work together to find better ways to communicate the message. It would be helpful to provide resources that allow people to self-measure and start to understand their own consumption better.’ The drinks industry also needs to share a responsibility in getting the message across, she stresses – they may have put unit information on labels but it ‘could be a lot bigger’.

As older people have been drinking for longer, the harm becomes accumulative, she points out, although the fact that over-50s are far from a homogenous group is itself a challenge. ‘You could have an extremely fit and healthy 73-year-old, versus a 52-year-old with multiple health issues. We think more discussion and exploration is required in relation to the guidelines and how we provide nuanced age-specific advice.’

There’s always been a strong Alcohol units graphanti-‘nanny state’ feeling in the UK, however, and many are likely to say, ‘If they haven’t got much else in their lives let them enjoy a drink – why take that away?’

‘The “nanny state” backlash is certainly something we’re prepared for and we saw this very much in the recent revision of the alcohol guidelines,’ she says. ‘However we believe that older people in particular do play an active role in their own health and wellbeing, and given the right information make healthier choices. How alcohol affects us, particularly as we age, is something most people would want to know about in order to make this choice, in the same way they would take care of other health areas.’

Assuming that older people don’t want to make healthy choices or live active and healthy lives is an ageist approach, she argues, adding that when they do access alcohol treatment they tend to have better outcomes – the problem is that they’re less likely to engage with treatment in the first place. ‘Assumptions that people are too old to change are unhelpful and actually quite discriminatory,’ she states.

If the aim is to help people experience a better quality of life in their later years, a key starting point is ‘clear and credible information’, she stresses. ‘Many people identified positive reasons for alcohol use such as socialising and relaxation, and these are important factors for people as they age. We’re not telling people not to drink – we’re highlighting what the particular risks are for older people and proving advice and information.’

People have to be motivated to improve their health, however. If someone is lonely, perhaps bereaved, and feel they have little to live for they may well know they’re doing themselves harm but think, ‘So what?’ What, realistically, can be done to counter that?

‘Of course major life transitions such as bereavement and retirement can be a trigger for increased alcohol use, and people may feel that there’s little in their life to change for. In our direct engagement and support service, where we work with people over 50 who are already drinking problematically, our philosophy is that it’s our job to help people find the motivation that will help them make that change. Very often the first stage of engagement is about relationship building and dealing with practical issues.’

The problem, she points out, is that it’s resource- and time-intensive. ‘We are very lucky to be funded so we can work in this way,’ she says. ‘What can happen with busy generic addiction and social work services is resources may be stretched, and if an older person – on the face of it – is not showing motivation to change, resources may be allocated elsewhere. We know that it takes time, repeated home visits, and lots of patience for someone to start to find their own drive for making a change, and this is the model we adopt.’

Equipping people with social supports and coping strategies – ‘resilience interventions’ – is also vital, she says, so that when they do experience difficult life changes they are better able to cope without turning to alcohol.

The report says that what’s needed is an ‘age-nuanced’ approach – what would some of the elements of that look like? ‘At a wider level there needs to be a multi-agency approach to ensure older adults don’t fall through the net,’ she says. ‘Frontline staff and practitioners should receive training that specifically challenges stigma and attitudes, whilst equipping people to better recognise and respond to older people who may be drinking.’

Among the best-placed people to step in are health professionals, particularly GPs, as they’ll usually be the ones older people have the most regular dealings with. What can be done to raise awareness among them, and help them spot any warning signs? ‘Health professionals have more and more demands on their time, but better alcohol screening of patients is a good starting point and in some areas this is already offered. If older patients are re-presenting with issues such as low mood, sleep disorders, stomach problems, then alcohol use may be a contributing factor.

‘It also may be the case that whilst people are not drinking at particularly high risk levels, they are experiencing some health implications due to age-related changes,’ she continues. ‘It’s important for community agencies to work closely together so that GPs have an easy and accessible referral route when they do identify someone.’