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Older people's drinking habits: Very little, very often

Official statistics on the consumption habits of older people in UK over recent years indicate that they consume fewer units than younger generations (see Young people and alcohol factsheet for more information), but that they are more likely to drink on an almost daily basis over the course of a week. It could be argued that compared to their children (and grandchildren, in the case of women aged 65 and over) older people drink very little, but very often. But the rising number of alcohol-related admissions/discharges and deaths in the UK among those aged 65 years and over highlights the health problems underlying their consumption habits.

 

Reasons for drinking and types of older drinkers

The sudden disruption in lifestyle caused by retirement and bereavement – which can lead to decreased social activity – is thought to be a major contributory factor among older people who develop a drinking problem, as are isolation and loneliness. Some justify the regular consumption of particular beverages (i.e. brandy, rum) on the grounds that it acts as an anaesthetic with medicinal properties which help remedy illnesses and pains, but this may instead help to foster a dependence on alcohol.

Researchers have identified 3 types of elderly drinkers:

 

  1. Early-onset drinkers (Survivors): those who have a continuing problem with alcohol which developed in earlier life. Because of the health risks connected to heavy drinking and dependence on alcohol, the lifespan of a problem drinker may be shortened by on average 10 to 15 years.
  2. Late-onset drinkers (Reactors): they begin problematic drinking later in life, often in response to traumatic life events such as the death of a loved one, loneliness, pain, insomnia, retirement, etc.
  3. Intermittent (Binge drinkers): they use alcohol occasionally and sometimes drink to excess which may cause them problems.

 

It is thought that both the late-onset drinkers and the intermittent or binge drinkers have a high chance of managing their alcohol problem if they have access to appropriate treatment such as counselling and general support.


Consequences of drinking for older people

Tolerance to alcohol is significantly lowered in the aged person, so it is possible that the same amount of alcohol can have a more detrimental effect than it would on a younger person. Older people are less tolerant to alcohol because of physical changes such as:

  • A fall in ratio of body water to fat, meaning there is less water for the alcohol to be diluted in
  • Decreased hepatic blood flow, leading to weakening of the liver
  • Liver enzyme inefficiency, so alcohol will not be broken down as well as in younger people
  • Poor kidney and liver function
  • An altered responsiveness of the brain; alcohol affects older brains more quickly than younger ones

It is therefore possible that the same amount of alcohol may produce a higher Blood Alcohol Concentration [BAC] in older than in younger people. Alcohol depresses the brain function to a greater extent in older people, impairing coordination and memory, and raising the likelihood of incontinence, hypothermia, injury by accident, and self-neglect.

The Royal College of Physicians once estimated that:

… perhaps up to 60% [of older people] who are admitted to hospital because of confusion, repeated falls at home, recurrent chest infections and heart failure, may have unrecognised alcohol problems. Some… are long-standing drinkers who have become old, others started drinking in old age… elderly widowers are the most vulnerable group.[1]

Other commentators claim that the current economic downturn has also played a major role in increasing current alcohol-related risk trends among older people. A recent paper by Stuckler et al demonstrated that a cut of 85€ in per-capita social welfare spending was associated with an increase of 2.8% in alcohol-related morbidity in Europe.[2]

But scientific studies have so far found no conclusive evidence to indicate an association between moderate long-term alcohol intake and lower cognitive scores in ageing individuals. There is limited evidence which suggests that low to moderate alcohol consumption among older people has a neuroprotective, rather than neurotoxic, effect.

However, with much higher levels of drinking among middle aged people (in their 40s and 50s), some experts in the medical profession predict that future generations of older people may see a disproportionate increase in alcohol-related versions of conditions, resulting in cognitive dysfunction and dementia.[3]

 

Diagnosing alcohol misuse in old age

Many of the symptoms of alcohol misuse can occur in the same way as other conditions caused simply by the onset of old age, thereby making alcohol misuse much harder to detect in older people, as it is obscured by non-specific illnesses and conditions such as gastrointestinal problems and insomnia, or misdiagnosed as dementia or depression. As a result, health professionals may recognise and diagnose the secondary medical problem, but fail to combat the possible primary cause.

 

Interaction with other drugs

Prescribed medication taken in conjunction with alcohol can cause adverse side effects. Older people are usually advised against drinking when taking other drugs. In a regular drinker, the simultaneous ingestion of alcohol with other drugs may diminish the drugs' impact, or increase the body's sensitivity to the other substance, depending on its strength. This is because the combination of drugs on alcohol (and vice-versa) can depress the rate of metabolism for both substances, thus altering their effect on the body (i.e. benzodiazipines). For example, drugs which act on the central nervous system, like diazepam [Valium], can depress the rate of alcohol breakdown, thereby exaggerating the effect of alcohol on the body, even in moderate amounts. Alcohol taken in conjunction with antidepressants such as Tofranil or Prothiaden may actually worsen the depression.

 

Good practices for the prevention of alcohol harmful use amongst older people

As one recent European study into alcohol and elderly people concluded, there is currently a lack of information about initiatives aimed at preventing the harmful effects of alcohol for older people, and despite a growing interest, alcohol use among older people is not yet perceived as a major issue for prevention.[4]

In 2008, the Institute of Alcohol Studies and Age Concern held a seminar to consider alcohol issues relating to older people.[5] The IAS believes that alcohol treatment and counselling of older people needs to be based on assessment and matching of each person’s needs to the range of treatment and services available. Emphasis needs to be placed on non-drinking social activities such as day centres and clubs in the context of the person's life circumstance and social support network; it may be necessary to work on redefining a social or family support mechanism.



References 

[1]   The Royal College of Physicians [RCP] (April 1987), 'A Great and Growing Evil?: The Medical Effects of Alcohol', Routledge Press, p. 11

[2]   Stuckler, D., Basu, S., McKee, M (July 2010)., 'Budget crises, health, and social welfare programmes', BMJ, Volume 341, in Scafato, E (August 2010)., 'Alcohol and the elderly: the time to act is now!', European Journal of Public Health, 20: 6, pp. 617–618

[3]   Dr Gupta, S (2008)., 'Alcohol-related dementia: a 21st-century silent epidemic?', British Journal of Psychiatry; Boston University School of Medicine Institute on Lifestyle & Health (May 2012), 'Critique 081: Alcohol intake in the elderly affects risk of cognitive decline and dementia', Abstract

[4]   Palacio-Vieira, J., Segura, L., Gual, A., et al (2012).,'Good practices for the prevention of alcohol harmful use amongst the elderly in Europe, the VINTAGE project', 48: 3, pp. 248–55, Abstract

[5]   Age Concern & Institute of Alcohol Studies (December 2008), 'Alcohol and Older People Seminar'