The kids are alright…
Alcohol consumption in the UK peaked in 2004 and fell every year for the following decade. This is undoubtedly a good news story, and one the alcohol industry is keen to shout about (and claim, largely undue, credit for). At the heart of this change is a substantial fall in young people’s drinking, with the current generation being branded as ‘generation sensible’ and ‘new puritans’ as a result. This phenomenon has been seen in many other developed countries and speculation currently rages about what may be the cause of this shift: was it the global recession? The internet? A change in youth culture? Or something else? It is undeniably an important and fascinating question, but there is a real danger that this is serving as something of a distraction while an altogether more concerning trend is occurring in older drinkers.
…what about older drinkers?
At the turn of the millennium, average weekly alcohol consumption decreased with age, with 18-24 year olds drinking most heavily, while the over 50s drank around half as much, on average. 43% of 18-24 year olds in the year 2000 regularly drank more than the current UK drinking guidelines compared to 26% of 55-64 year olds. By 2016 this pattern had changed completely, with 30% of 55-64 year olds exceeding the guidelines compared to 18% of 18-24 year olds. Since 2012, the age group with the highest levels of drinking has been 55-64 year olds.
These trends are worrying, but perhaps it is more important to look at the equivalent trends in the harms associated with drinking – do we see a similar pattern there? Alcohol consumption increases the risk of harm from a wide range of health conditions, from liver disease and injuries to several types of cancer. Some of these, such as alcohol poisoning, are only caused by alcohol, but others, such as heart disease, have many risk factors of which alcohol is only one. It is therefore tricky to track the changing burden that alcohol places on the nation’s health. The simplest approach is to look at those conditions which are only caused by alcohol, so-called ‘alcohol-specific’ causes.
If we focus on these alcohol-specific causes, the overall rate of deaths from these causes has increased gradually in England since 2001. But when we dig into the details of this rise, we can see that it has happened almost exclusively in people aged 55 and over. There has been almost no change in rates of death from conditions such as alcoholic liver disease in the under 50s in the last 16 years, while they have increased by around 50% among people in their 60s.
As with the falls in youth drinking, England is not alone in seeing increasing drinking among the over 50s. Similar trends have been observed on the other side of the world in Australia and New Zealand. There is also evidence that the rates at which the over 50s are accessing alcohol treatment services has risen significantly over the same time period, with 5 times as many people over 65 receiving treatment in 2017/18 as in 2005/06 according to figures from Public Health England.
In spite of this, alcohol is still widely portrayed in the media as a problem confined to young people. Media headlines around the harms of alcohol are routinely accompanied by pictures of drunken young people, particularly young women. Even Duncan Selbie, the Chief Executive of Public Health England hailed the introduction of Minimum Unit Pricing in Scotland as something which would address the drinking of young people, in spite of the fact that older drinkers are much more likely to purchase the cheap alcohol which is affected by the policy. Similarly the World Health Organization advocates raising taxes on products which are particularly favoured by young drinkers.
The way forward?
There is a serious danger that the good news story of falling youth drinking is distracting attention from worrying rises in levels of alcohol consumption and harm in the over 50s. Alcohol policy needs to address this new reality and cut its cloth accordingly, with approaches tailored to the specific needs of older drinkers. For example, arbitrary age limits placed on alcohol treatment services may exclude older drinkers entirely and where services are available they are frequently not designed to accommodate older age groups. Healthcare professionals should be more aware of the levels of heavy drinking in older age groups and be prepared to act accordingly. Brief Interventions are a key pillar of the current policy response to alcohol problems, but even though people in their 50s are the most likely to be identified as in need of intervention when asked, practitioners are currently far more likely to ask a 25 year-old about their drinking than a 55 year-old. An approach to addressing alcohol harm which more accurately reflects the distribution of harm is far more likely to be effective. The latest estimates suggest that two-thirds of all hospital admissions caused by alcohol occur in the over 55s, compared to 3% of them in the under 25s. The sooner policy starts to reflect this disparity, the sooner we might start making inroads into reducing the harm associated with alcohol.
Written by Colin Angus, Research Fellow at the Sheffield Alcohol Research Group within The School of Health and Related Research. Originally appeared on the Drink Wise Age Well website on Tuesday 22 January 2019.
All IAS Blogposts are published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Institute of Alcohol Studies.