Alcohol Policy UK

Briefing warns of sharp rise in admissions of older people with alcohol-related mental health problems

An Alcohol Concern briefing has warned of a 150% rise in hospital admissions for over 60’s with alcohol related mental health problems in the last decade. The briefing 'Trends in alcohol related admissions for older people with mental health problems: 2002 to 2012' finds a disproportionate rise amongst older adults, despite an overall rise in all adults and accounting for a growing older population. 

The analysis looks at hospital data for those admitted to hospitals in England with mental and behavioural disorders associated with alcohol use. Dr Tony Rao, an alcohol and older people mental health specialist and author of the report, warned that “increasing numbers of older people are living with alcohol related dementia, anxiety and depression – and it’s their loved ones, carers and the rest of society who are left picking up the pieces."

The report also found a 140% increase over the last decade in the number of over 60’s being admitted to hospital with Wernicke Korsakoff syndrome – a form of brain damage caused by alcohol use.

Recently an Alcohol Insight found a significant and growing number of older people are at risk of alcohol-related harm, and that alcohol problems are less likely to be detected in older people. Barriers to identification included complex physical and social problems, including a lack of awareness amongst professionals in recognising alcohol misuse, or barriers for older people to access help.

A 2012 report from the Royal College of Psychiatrists advised over 65's should not drink more than 1.5 units of alcohol a day, and separate recommended guidelines should be considered.

See here for an Alcohol Concern Wales briefing paper and presentations from an alcohol and older people event. See here for a RCP leaflet outlining the key alcohol issues and risks for older people.

See here for the latest annual statistics on alcohol for England 2012.

Health Survey for England 2011: latest figures on reported consumption

Findings from the the Health Survey for England 2011 have been released, including chapter 6: drinking patterns and chapter 7: drink diary. See here for the trend tables, trend commentary and press release.

The report broadly reflects known general consumption patterns. Young adults are more likely to drink heavily (binge) on a single occasion, but drink on fewer days in the week. Adults over 45 are more likely to drink on most days, but tend to drink less per day. Those from higher socio-economic groups are more likely to drink above the guidelines and do so more regularly. Men drink significantly more than women across most age groups.

The drink diary chapter is a new addition to test how reported consumption matches up when recorded by the drinker. Although reported frequency of drinking tended to match, consumption levels tended to be under-estimated when compared with a drinks diary. The survey data is still considered reliable in determining consumption patterns and variations across age, sex, region and income groups.

Some specific findings include:

• Focusing only on those who drank alcohol in the last week, over half exceeded recommended limits on at least one day in the previous week (56% of men, 52% of women), while over a quarter drank more than twice the recommended limit (31% of men, 25% of women). Men drank an average of 7.7 units, and women an average of 5.0 units on the day they drank the most in the last week.
• Younger people were the most likely to drink heavily on a single occasion: 67% of men and 68% of women aged 16-24 drank above the recommended level, and 45% and 46% respectively drank more than twice the recommended amount.
• The proportion of men consuming more than four units on the heaviest day’s drinking in the last week did not show substantial change between 2006 and 2011 (39 per cent in 2011), and similarly the proportion of men that drank more than twice the recommended amount showed little change over the period (22 per cent in 2011).
• The picture was different among women: there was a decrease between 2006 and 2011 both in the proportion consuming more than three units on the heaviest day’s drinking last week (from 33 per cent to 28 per cent), and in the proportion drinking more than twice the recommended amount (from 16 per cent to 13 per cent).

The figures prove interesting given indications that overall alcohol consumption has been falling since 2004. However consumption it still significantly higher as a longer term trend, and it has been suggested that consumption may have dipped in part due to the recession. A continuing rise in alcohol-related and primary alcohol attributable hospital conditions is also set to continue for sometime.

See here for the comprehensive statistics on alcohol for England 2012.

Working with Older Drinkers: Alcohol Insight warns of growing need to recognise alcohol problems amongst older people

An Alcohol Insight funded by Alcohol Research UK has explored alcohol problems and treatment needs need amongst older adults. The project found that evidence suggests a significant and growing number of older people are at risk of alcohol-related harm: 

• 20% of men and 10% of women aged 65 and over exceed recommended drinking guidelines and 3% of men and 0.6% of women aged 65-74 are alcohol dependent.
• There has been a steady increase in the amount of alcohol consumed by older age groups in recent years.
• Consumption patterns suggest that the ‘baby-boomer’ cohort is likely to have higher levels of alcohol consumption in old age than previous cohorts of older people.

The Insight found alcohol problems are less likely to be detected in older people as a result of complex physical and social problems, including a lack of awareness amongst professionals in recognising alcohol misuse, or barriers for older people to access help. See the full report here.

However older drinkers are just as likely to benefit from intervention as younger drinkers, though approaches should focus on quality of life in addition to issues surrounding alcohol and aim to promote independence and reduce risk. The Insight recommends further understanding amongst health and social care staff and substance misuse practitioners into the complex factors affecting older adults and alcohol misuse. It also suggests further recognition by commissioners and prevention programmes that address risk factors and strengthen protective factors.

Earlier this year a report from the Royal College of Psychiatrists advised over 65's should not drink more than 1.5 units of alcohol a day, and separate recommended guidelines should be considered. An Alcohol Concern Wales briefing paper was released earlier this year and presentations from an alcohol and older people event are available here. See here for a RCP leaflet outlining the key alcohol issues and risks for older people.

Older people advised to drink less than adult guidelines by Royal College of Psychiatrists

A report from the Royal College of Psychiatrists advises people over 65 should not drink more than 1.5 units of alcohol a day - at least half the standard adult daily guidelines. The reduced amount advised for older adults is the equivalent of about half a pint of lager (5%) or a small glass of wine.

See the full RCP report Our Invisible Addicts which states:

"Current recommended ‘safe limits’ for alcohol consumption are based on work in younger adults. Because of physiological and metabolic changes associated with ageing, these ‘safe limits’ are too high for older people; recent evidence suggests that the upper ‘safe limit’ for older people is 1.5 units per day or 11 units per week"

However the advice has caused some hostile reactions. Speaking on a BBC report, Emma Soames of Saga described the advice as "unbelievable", stating "the levels are so ridiculously low that I don't think people will take them seriously". However charities such as Age UK and Alcohol Concern backed calls for greater awareness and work to address alcohol harm amongst older adults. See further coverage from the Guardian blog and Daily Mail.

The report itself provides detailed insights convened from a older persons substance misuse working group. It includes a series of recommendations including further policy recognition and the development on specific drinking guidelines for older adults. Improved treatment and early intervention to address alcohol harm and further research and training are also advised, warning against misconceptions that alcohol problems are associated mainly with younger people.

The RCP have a leaflet outlining the key alcohol issues and risks for older people. An Alcohol Concern Wales briefing paper was released earlier this year and a series of presentations from an alcohol and older people event are available here.

Hidden harm? Alcohol and older people in Wales

Alcohol Concern Cymru have released a briefing paper on alcohol and older people:

Hidden harm? Alcohol and older people in Wales [pdf]

An Alcohol Concern page states:

'To make sure older people in Wales receive the support they need to enjoy alcohol healthily, Alcohol Concern is recommending that professionals working with older people need to be aware of alcohol misuse; better joint working is needed between local older people's services and alcohol treatment services; and research is needed into whether current unit guidance and screening methods for alcohol misuse are relevant to older people.'

A respected paper on the subject by Dr Karim Dar is available here - Alcohol use disorders in elderly people: fact or fiction?. Last year an alcohol and older adults regional event was held in the South West of England - see the presentations here. A leaflet on the subject has also been produced by the Royal College of Psychiatrists - content here.

Alcohol and Older People event pt.1: Alcohol and mental health event for social care

An event for health and social care workers exploring 'Alcohol and drug use among older people and people with mental ill health'  took place in March this year. The conference was organised by the British Association for Social Workers (BASW) led by the Alcohol and Drugs Special Interest Group. Presentations (ppt.) from the day included:

• Drinking Buddies, Happy Memories and Taking to the Bottle: Alcohol and Later Life Professor Marian Barnes and Dr Lizzie Ward, University of Brighton
• Alcohol and other drug use amongst older people' (large file) Ilana Crome, Professor of Addiction Psychiatry, Keele University Medical School
• Reaching out to Older Drinkers - a new practice model Greg Scott, Foundation 66
• Mental Health and Substance Use Derek Tobin, Compass Programme, Birmingham and Solihull NHS
• Evidence based interventions in Dual Diagnosis Ian Wilson, University of Manchester. 
• Access the Manchester Dual Diagnosis Service (MDDS) pathway and referral form here: MDDS ICP and Referral doc.

An event exploring Alcohol and Older People also took place in the South West this year - see here for event presentations.

Alcohol and Older People event pt.2: taking notice in the South West

An event exploring Alcohol and Older People issues and responses took place in March, organised by the South West Alcohol Improvement Programme and the AERC Alcohol Academy. Presentations from the day included:

• Alcohol and Older People: Context Issues and the Future provides an overview of the issues affecting the elderly with policy recommendations from an AERC facilitated roundtable discussion.
• Specialist approaches in alcohol treatment for the elderly presentation exploring some of the existing models of specialist alcohol treatment for older people and identifying some of the key issues and challenges.
• Age and Alcohol in the South West - A Double Whammy Looks at the factors affecting the behaviour of the elderly and provides an introduction to some of the Age Concern/ Help the Aged projects in the South West.
• Identification and Brief Advice Summary of research into barriers and motivators to delivering IBA and where to order materials and find out about the new national alcohol campaign.
• Vintage - Good Health into older age Provides a rationale and context of the Vintage European alcohol project and additional resources.
• Alcohol and Older People A Gloucestershire perspective Provides a summary of the alcohol project and strategy in Gloucestershire.

An event exploring alcohol and drug use among older people and people with mental ill health also took place this year - see here for the event presentations.