Older drinkers falling through the cracks

Older adults are now one of the fastest growing populations of hazardous drinkers, yet health systems are failing to identify them and address their needs until their condition is critical, according to new research.

A review of international survey data, including US National Surveys on Drug Use and Health and the Australian Department of Health National Drug Strategy Household Survey, found growing epidemiological evidence that hazardous drinking was a major public health concern in older populations.

Estimates for the number of older people drinking at risky levels varied widely, from one to just over 20 per cent.

An Australian national survey found older adults drank more frequently than younger age groups, albeit at lesser levels. New data from Victoria found the greatest increase of all ambulance attendances involving alcohol intoxication was in those aged over 50.

In New Zealand, up to 40 per cent of older adults were hazardous drinkers, with the over-50s drinking more frequently and more on each occasion than older adults in nine other countries, including England, Russia, the United States, Mexico and China.

The research was presented by teams from Massey University, University of Auckland, and the University of New South Wales (UNSW), Australia at this week’s Australasian Professional Society on Alcohol and other Drugs (APSAD) Scientific Alcohol and Drug Conference in Auckland.

“Baby boomers worldwide are drinking more than previous generations of older adults and many are drinking at harmful levels,” said Dr Andy Towers of Massey’s School of Health Sciences. “We need to take action now to cut the rate of hazardous drinking in this group, maintain their health and reduce reliance on care.”

Older drinkers presented unique challenges, particularly for clinicians and health professionals. Older adults had higher physiological sensitivity to alcohol, more co-morbid health conditions and use of medications that alcohol could interfere with, a higher risk of alcohol-linked mental health issues, and a greater likelihood of alcohol-related injuries and death.

Research from Australia also established alcohol-related dementia to be the leading cause of young onset dementia (onset of symptoms before age 65), accounting for nearly 20 per cent of cases.

Troublingly, a recent French data linkage study involving more than 30 million participants put this rate even higher, at 40 per cent.

“There is increasing evidence that alcohol is an important, modifiable risk factor for cognitive impairment and should be a target for dementia prevention campaigns. Alcohol is a risk to brain health that we simply cannot ignore any longer,” said lead researcher Dr Adrienne Withall, from the School of Public Health and Community Medicine at UNSW Australia.

“Many older people in our research expressed that they would like their doctor to give them more information about alcohol use and services,” she said.

“We need to get the message out there that older people should ideally limit their drinking to one standard drink a day, with two alcohol free days per week. Unfortunately, we believe that there is no safe level of drinking for people with dementia.”  

Despite seeing their GPs frequently, many older drinkers were missed because health professionals often lacked specific training on identifying key risks and the use of inappropriate screening tools that neglected key health-related risk factors.

“Many older adults and their GPs feel uncomfortable discussing alcohol use, many do not understand what a standard drink is nor what the low-risk guidelines are, and many labour under the assumption - now seriously in question - that a bit of alcohol is good for you,” said Dr David Newcombe, Director of the Centre for Addiction Research, University of Auckland.

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