Alcohol has been used for millennia as a social activity. For many, it is a rite of passage to adulthood when alcohol can be legally bought over the counter. Throughout our adult lives, alcohol is central to celebrations such as birthdays, and weddings, at sporting events while we watch our favourite teams play and sometimes lose, as well as our social activities. Its use is embedded in our everyday psyche and our culture. Yet, while alcohol use in younger age groups is decreasing, these declines in drinking are not evident among older adults. Indeed, it could be argued that the 21st century has become the century of the older drinker, with alcohol being the drug of choice for a wealthy population of baby boomers. The research evidence shows us that older adults are drinking at levels not seen in previous generations of retirees and this poses a number of problems.
Excessive alcohol use at any age is problematic; however, ageing increases the risks of any alcohol use. This is because the way we metabolise alcohol changes with age, and there are risks associated with combining medications and alcohol use. All of which makes older adults a key at-risk population of drinkers. Yet, there is a common misconception that older adults don’t drink to excess. This is partly because older drinkers are invisible. Older drinkers are not the largest group of drinkers in our city centres on weekends. Yet, they are drinking, with some drinking to excess at home or in their local pubs. It could be argued that because of this ‘invisibility’, older adults are not routinely screened for alcohol use within the health system.
An additional problem is that primary health care professionals are not adequately prepared to screen and manage older drinkers, and our health systems are not designed to cater for an impending wave of older drinkers in need of treatment. At the same time, alcohol policies across the UK currently do little to stem the tide of harm for older drinkers. In order to explore some of these issues The Centre for Ageing and Dementia Research held a one-day conference in May at the Principality Stadium in Cardiff, bringing together experts in the field from across the UK and New Zealand.
There was a great deal of interest in this event and places filled up fast with delegates attending from across the UK. The programme was varied and began with Dr Claire McEvoy exploring the associations between cognitive impairment and alcohol use. She was followed Dr Tony Rao, a leading Consultant Old Age Psychiatrist, who highlighted alcohol as one of the top five leading contributors to years of healthy life lost (Disability-Adjusted Life Year /DALYs). His presentation also demonstrated the importance of adequate screening for alcohol, as alcohol disorders can complicate other dementias such as Alzheimer ’s Disease and Vascular Dementia, while alcohol related cognitive impairment can be missed. This has implications for future health as studies show that stopping drinking can stabilise alcohol-related cognitive function with some brain changes being reversed.
The screening of older patients for alcohol use was the subject of the talk given by Dr Andy Towers who presented a study of an e-screening tool being piloted in New Zealand. This e-screening tool can flag up risky patients using an algorithm, which then triggers specific questions to be asked of the patient with regards to their alcohol consumption. This is an exciting development as it is unobtrusive for the health practitioner to use, as it forms part of their routine screening, but can flag up issues with drinking levels. This has the potential to remove the discomfort of asking older patients about their alcohol use, while aiding early interventions if individuals are drinking to excess, as well as minimising interactions between prescribed medication and alcohol.
The programme then moved on to explore ageism in alcohol policy practice and research. This fascinating talk by Dr Sarah Wadd provided compelling evidence of ageism within rehab services. Evidence provided showed how older adults being offered rehab services were exposed to bullying, and intimidation by other clients because of their age. Older adults were offered activities that were not age appropriate. Most concerning was the evidence that older adults are not being offered alcohol treatment on age-related grounds, which is of concern as evidence suggest that older drinkers respond well to treatment.
In contrast, Dr Beth Bareham presented work from her PhD which had explored the disconnect between older people’s perceptions of their drinking and the health-related risks. Using quotes from her interviews with older drinkers, Beth highlighted the ritualised and routine nature of drinking. One of the findings from Beth’s presentation, which was of particular interest to me, was how some people used alcohol to mediate social contact, resulting in a social dependence on alcohol for social contact. This is consistent with some of the findings from my work where older adults were using alcohol for social contact to alleviate loneliness or solitary drinking to mitigate the effects of loneliness.
The final presentation of the morning was by Julie Breslin who spoke about the work of Drink Wise Age Well. Julie spoke about their work across the four UK nations on the charter for change ( https://drinkwiseagewell.org.uk/research/) . The charter for change was co-created by people with lived experience and experts in alcohol and ageing, across the four Nations and Julie provided insights around how older drinkers can be supported to live free from alcohol-related harm.
The buzz in the room over lunch was great, everyone was chatting and sharing their work and making those important connections. This continued after lunch when questions posed by delegates were placed on a slide and roundtable workshops began with each table choosing the questions they wanted to answer. These ranged from questions around the link between loneliness and alcohol use, the role of primary care in addressing alcohol use in older adults, and the role of community pharmacists in addressing alcohol use and medications. The conversations were wide ranging and some people shared evidence of good practice that already exists, while others highlighted gaps in the current knowledge base. The delegates were clearly very engaged in the discussions and conversations continued long after the event had finished.
The event has highlighted the need for more research in this area and further demonstrated the benefits of bringing together practitioners and academics to share knowledge and experience in order to develop research that is relevant to those who will ultimately use it. As researchers, our aim is to develop research that makes a real difference to the lives of older adults globally. We can only achieve this by working with older adults with lived experience and those on the frontline of services.
Dr Deborah Morgan is a researcher at the Centre for Ageing and Dementia Research