SNP Conference 2016 Fringe event – Panel Discussion Brief
To our Good Health: is our ageing population a high-risk group in
terms of alcohol related harm?
Event Details
Date: Thursday October 13th
Time: 5.30pm-6.30pm
Venue: Alsh B, SECC
Chair
Stephen Naysmith, The Herald
Panel members
Representative TBC, Age Scotland
Maureen Dutton, Peer Researcher, Substance Misuse and Ageing Research Team, University of
Bedfordshire
Dr. Peter Rice, Chair, Scottish Health Action on Alcohol Problems (SHAAP)
Julie Breslin, Head of Programme, Drink Wise, Age Well
Background
The Scottish Government has globally led the way in reducing alcohol related harm in the Scottish
population through our national alcohol strategy. They have ensured full scrutiny of this with the
Monitoring and Evaluating Scotland´s Alcohol Strategy (MESAS) managed by Health Scotland which has
evidenced positive improvements in levels of consumption and alcohol related harm. However we are
not quite seeing the same positive changes in our older population, in fact the proportion of older adults
exceeding recommended guidelines is increasing, as is the level of alcohol- related harms in this age
group. The size of our ageing population is also growing. Our ageing population contributes very positively
to our society (a recent Royal Voluntary Service study shows nearly half of 55-74 year olds currently
volunteer 2) but if we fail to recognise and adequately respond to the current trend of alcohol use in our
older population, we may see a significant impact on our health and social care services in the future.
The final MESAS report 1 shows that since 2009 we have started to see a decrease in our alcohol
consumption in Scotland. The report states that the downward trend in self-reported consumption
1
appears to be driven by declining consumption and increased abstention in young adults, and decreased
consumption amongst the heaviest drinkers, particularly men 1
However, whilst there has been a sharp downward trend in weekly consumption in the 16-24 year age
groups, there has been little or no reduction in older age groups The MESAS report shows those aged 4554 and 55-64 consume more alcohol per week than other age groups 1.The proportion of adults
exceeding recommended drinking guidelines decreased between 2008 and 2012. However, the
proportion of 65 to74 year olds exceeding drinking guidelines increased over this time 3
A recent European Commission for Human Rights report shows that growth between 2001 and 2011 in
people aged over 50 was equivalent to 98 per cent of the rise in Scotland’s overall population. This is
due to both people living longer and larger numbers of people turning 50 4 According to the Royal College
of Psychiatrists Invisible Addicts Report (2011) “between 2001 and 2031 there is expected to be a 50%
increase in the number of older people in the UK . The number of older men and women drinking above
recommended guidelines is also increasing” The report goes onto argue that this is something we need
to actively address if we don’t want to see a negative impact of these combined factors on our health
and social care services 5.
Compounding the issue is that drinking in an older population can also be more easily hidden. For three
quarters of Scots, the most common drinking location is the home and this proportion increases with age
6. At home, measures are often freely poured so it is difficult to even know how much is being consumed,
or whether this is within recommended guidelines. Data taken from our Drink Wise, Age Well programme
in Glasgow shows that 88% of those accessing support typically drink at home, alone.
So in summary the main concern is that while trends show alcohol consumption levels are decreasing in
the younger and general population, this is not the case in older people. They are a more hidden
population, often harder to reach and engage so we are potentially going to see this age group becoming
most at risk to alcohol related harms
Alcohol Related harm
Alcohol health harms in an older population tend to be accumulated over a period of time. Harms in
young people tend to be acute and caused by intoxication, poisoning or injury, however in older adults it
is more likely to be physical health problems such as liver disease, heart disease and cognitive
impairments that have developed over a longer period. In Scotland those aged 45- 54 and 55-64 are the
age group most likely to have an alcohol-related admission to hospital. All age groups have seen a
downward trend in alcohol-related hospital admissions in recent years but the reduction has been
greatest in younger age groups 9.
It is important to emphasise that the general acute hospital stay rate was nearly 8 times greater for
individuals living in the most deprived areas 9, so it is possible to say those with lower socio economic
status are much more at risk of alcohol related harm. 1.6 million pensioners (14%) live below the poverty
line, with incomes less than £224 per week after housing costs 10.Our internal Drink Wise, Age Well data
shows that 57% of those accessing support are out of work or looking for work, and a further 67% state
that their drinking impacts negatively on their finances and 26% have increased their alcohol use due to
financial worries. This cohort of people who are older, income deprived and drinking are likely to be the
most at risk of alcohol-related harm.
Alcohol related deaths have generally been highest in 55-64 year olds, followed by 45-54 year olds and
65+ years 1.However the data collected for alcohol-related deaths only includes those causes regarded
as being most directly due to alcohol consumption (e.g. alcoholic liver disease) and don’t include other
conditions which are partly attributed to alcohol (e.g. cancers of the mouth, oesophagus and liver) or
external causes (e.g. alcohol-related falls, road traffic and other accidents). It is possible that the number
of deaths attributed to alcohol could be much higher
2
Another significant harm that is worthy of consideration is dementia and alcohol. Dementia is already
very common in Scotland with 90,000 people having the condition and the number of people with
dementia in Scotland is increasing, primarily because the population is getting older. Although the link
between alcohol and different forms of dementia is still not fully understood, research does show that
alcohol can be a risk factor for dementia. Alcohol use can lead to some cognitive impairment and
prolonged, heavy drinking can lead to alcohol related brain damage including in severe circumstances
Wernicke's encephalopathy 11.However a Life Changes Trust Survey on dementia awareness found that
only 3% of people correctly recognised all five identified risk factors for dementia (high blood pressure,
heavy drinking, smoking, diet and family history) 12.
At the start of 2016, Drink Wise, Age Well produced our state of the nation report with ILC-UK which
surveyed the drinking behaviours of nearly 17,000 adults aged over 50 in various UK locations including
Glasgow and Dundee Whilst the report showed the majority of adults aged over 50 are drinking at ‘lower
risk’ levels it does reveal that 1 in 5 of those who are drinking are doing so at ‘increasing risk’ levels. This
means that they are drinking amounts whereby if they continue to do so may start to experience a number
of alcohol related harms and for some they will be experiencing these harms already. And these harms
are not just health related; they can include problems with relationships, caring roles, well-being, finances
and mental health. Many of the higher risk drinkers in the study said they were drinking as they felt
depressed, felt lonely and higher risk drinkers are less likely to feel part of their community. Social
isolation and a disconnect from others seems to be the prevailing issue for this this group who disappear
more and more below the radar 13.
Social Isolation and alcohol
Without even taking alcohol into consideration, we already know that social isolation can have a
significant impact on the health and well-being of older people 14. The Institute for Research and
Innovation in Social Services (IRISS) highlights that people who are lonely are more likely to have health
issues such as high blood pressure, poor sleep and depression 15. Two-thirds of older Scots live alone
and are potentially cut off from society due to health problems or a lack of public transport4.
Drink Wise, Age Well programme data from the Glasgow services shows that 73% of those using the
service live alone. At assessment 73% reported to feeling lonely, and 45% felt socially isolated 8.
Those surveyed for the Drink Wise Age well report whose drinking had increased, cited retirement,
bereavement, isolation and loss of sense of purpose as contributing factors 13 Retirement and
bereavement in later life can lead to a reduction in social networks and connections.
We need to explore further the connection between social isolation and increased alcohol use and
address this using a whole systems approach.
Stigma and awareness
A significant finding from the Drink Wise, Age Well survey was the level of stigma and shame associated
with alcohol use in later life. 55% of adults aged over 65 who gave an opinion believe that people with
an alcohol problem have themselves to blame, and nearly a third would not tell anyone if they had a
problem 13
Another concern is that alcohol use often remains below the radar. Of those surveyed drinking at
increasing risk levels, four out of five had on no occasion been asked about their alcohol use by friends,
family or health professionals. This may be due to assumptions that older adults don’t have problems
with alcohol use, or an attitude that they will not want to make changes at that stage in their lives.
However there is no evidence to show that older adults do not make positive changes, and some research
3
shows that in alcohol treatment, older adults have better outcomes than any other age group 17. Another
concern is that three quarters of those surveyed were unable to identify alcohol guidelines13. This means
that those exceeding recommended guidelines, may not even be aware they are doing so.
Whilst raising awareness in adults over 50 around the risk associated with alcohol use, it is equally
important to work with professionals and people who support older adults, to better recognise and
respond when there may be problems with alcohol use. The table below identifies the key diagnostic
criteria for problem drinking, with specific considerations for older adults
Table 1 (Taken from RCOP Our Invisible Addicts ) Applying DSM-IV diagnostic criteria for substance dependence to older
adults (adapted from Blow,1998)
Criteria
1 Tolerance
2 Withdrawal
3 Taking larger amounts or over a longer
period than was intended
4 Unsuccessful efforts to cut down or
control use
5 Increased time spent obtaining
substances or recovering from effects
6 Giving up activities because of use
7 Continued use despite physical or
psychological consequences
Special considerations for older adults
Even low intake may cause problems owing to
physiological changes
May not develop physiological dependence
Cognitive impairment can interfere with self-monitoring
Reduced social pressures to decrease harmful use
Negative effects can occur with relatively low use
Decreased activities because of comorbid psychiatric
and physical disorder
Social isolation and disability making detection more
difficult
May not know or understand that problems are related
to use, even after medical advice
Failure of clinician to attribute problems to alcohol or
drug misuse
This table summarises effectively the key issues for older drinkers
•
As people get older their ability to absorb and breakdown alcohol reduces, making them more
susceptible to alcohol health harms
•
Older adults may be at more risk of the toxic affects of alcohol on their brain, which can impact
on memory and cognitive functioning
•
Assumptions may prevail that older adults don’t want to or need to change their alcohol use
•
Alcohol use in older adults can be more hidden as they may be more isolated, or ashamed of their
drinking
•
Health Professionals may attribute health problems to ageing rather than alcohol use
It is important we start to discuss the issue of alcohol and ageing more proactively, to challenge any
stigma that prevails and ensure people over 50 are given the correct information to make healthier
choices about their alcohol use, whilst professionals and frontline workers know how to recognise and
respond to problem drinking. Many older adults drink at lower risk levels and it is important to
acknowledge that for many, alcohol use is a very sociable and enjoyable experience. Also many older
adults want to remain healthy into their later years. In a Centre for Ageing Better Survey of people aged
over 50, 53% cited good health as the most important factor in having a good later life 16. By starting the
4
conversation about alcohol use in later life, we can provide some solutions to ensuring our ageing
population live longer, healthier lives
Moving Forward
In Glasgow, the Drink Wise, Age Well project aims to help people make healthier choices about alcohol
as they age and help professionals recognise and respond to the needs of older adults whose alcohol
use places them at risk of harm. From prevention workshops to work-force development and training we
work to increase awareness and knowledge of the issue. Our resilience activities particularly target
people who are socially isolated or experience life transitions through offering group activities,
volunteering and social supports. The programme also provides one-to-one and family support via an
outreach service in the community to people who are experiencing alcohol problems.
Older adults may come into contact with a number of services including health, housing and social care.
It is important that we don’t operate in silos, and developing joint working protocols and strong
partnerships will ensure people don’t fall through the net, leading to better outcomes
Workforce Development and training for professionals and frontline staff that takes into consideration
alcohol and ageing factors should be made widely available
There should be more awareness of cognitive impairment risks with alcohol, and its link to dementia, and
where appropriate cognitive screening tools should be adopted within alcohol treatment and older adult
services.
In Scotland needs assessments and commissioning of alcohol services should take into consideration
the specific needs of older drinkers (e.g. outreach support)
Our key national strategies on alcohol and healthy ageing, should explore the risk and impact of alcohol
and ageing
We must ensure treatment services and our data collection sources for understanding alcohol and ageing
does not discriminate against older adults e.g. have cut off ages
Key Questions to explore Together
the panel will explore key questions:
-
Do we need age specific policies, public health messaging and interventions for our older
population?
-
How we work better together to reduce stigma and raise awareness of the needs of this
population?
-
How do we work together to stop the most vulnerable older people who drink falling through the
net with the outcome being repeated hospital admissions?
-
How do we as a nation better prepare and respond to the contributing factors that lead to
increased alcohol use i.e. retirement, bereavement loss of sense of purpose?
By exploring the above questions we hope to be able to contribute to the following national outcomes
•
We live longer, healthier lives
5
•
Our people are able to maintain their independence as they get older and are able to
access appropriate support when they need it.
Panel Members Biographies
Stephen Naysmith (Chair) The Herald
Stephen Naysmith covers the public and voluntary sectors and writes leader articles for the Herald
and has been covering social and youth issues, health and social care and public policy for more than
20 years. He is a member of the Glasgow Children's Panel, a keen cyclist and allotmenter and enjoys
hunting for wild mushrooms.
Maureen (Moe) Dutton Peer Researcher Substance Misuse and Ageing Research Team, University of
Bedfordshire
Maureen (Moe) Dutton is Public and Expert by Experience Researcher (PEER) in the Substance Misuse
and Ageing Research Team (SMART) at the University of Bedfordshire. She is also a national service
user representative for the drug and alcohol charity Addaction. Moe, has been in recovery from a later
life alcohol problem for 3 years. She now conducts research and raises awareness of
alcohol problems in later life. She is principal investigator for a study exploring the acceptability of
detox and residential treatment services for older adults and is conducting interviews with older
adults with alcohol problems for the Big Lottery funded Drink Wise, Age Well programme. She is a
member of an advisory group of policy makers that meets regularly to discuss alcohol use in later life
in the House of Lords. Outside of work, Moe is a keen runner . She lives with her husband on the
outskirts of Manchester.
Julie Breslin, Head of Programme, Drink Wise, Age Well
Julie Breslin has worked in the homelessness and addiction field for nearly twenty years, starting her
career in Dublin with the homelessness charity Focus Ireland. In 1998 she moved to Glasgow and
following the completion of a Post Grad Diploma in Addictions began working in statutory addiction
services.
Julie joined Addaction in 2006 and since then has managed a number of alcohol
Services in Glasgow including the Over 50s Alcohol Service which was awarded the Herald Society
Awards Health Provider of the year in 2012. Julie has a keen interest and commitment to the issue of
6
alcohol use and health ageing and led on the Big Lottery Fund Application for Rethink Good Health
which resulted in the UK wide Drink Wise, Age Well programme
Dr. Peter Rice, Chair Scottish Health Action on Alcohol Problems (SHAAP)
Peter Rice is an Addiction Psychiatrist based in Scotland. He graduated from Glasgow University and
his post graduate training was in Glasgow, Perth and Dundee. He has been Chair of Scottish Health
Action on Alcohol Problems, a project of the Royal College of Physicians of Edinburgh, since 2012. He
was one of the group of doctors from the Scottish Royal Colleges who founded SHAAP in 2006 to
raise awareness of the extent and diversity of alcohol related harm and promote effective policy
solutions initially within Scotland and subsequently in the UK, Europe and internationally.
He is chair of Tayside Council on Alcohol (a local alcohol charity) alcohol policy lead for RCPsych (UK),
member of the UK Alcohol Health Alliance, Board Member of the European Alcohol Policy Alliance
(Eurocare) and a Consultant to WHO Europe. He is past chair of the Royal College of Psychiatrists in
Scotland.
From 1989-2013 he worked in an NHS Alcohol Problems Service seeing patients
and working with colleagues and partner agencies. He applied population health principles to his
clinical service with a focus on prevention, early intervention and care pathways and this led to
increasing involvement in formal policy work. His work with the Royal College of Psychiatrists focused
on the impact of mental and behavioural health to population health and health inequalities. He has
researched and published on health information and communication, brief interventions, on
counselling relationship in alcohol misuse treatment as well as on more traditional medical topics
such as cell changes in oral cancer. He has published on Minimum Unit Pricing in the British Medical
Journal and British Journal of Psychiatry.
He was part of the SHAAP group who developed the proposal for Minimum Unit Pricing in 2007 which
was adopted by the Scottish Government and became law in 2012. He is currently closely involved in
the process of implantation of Minimum Unit Price, including work with colleagues and institutions
elsewhere in the UK and in Europe.
He is an adviser and co-applicant with a number of research projects including the development of
alcohol screening and brief interventions in dental practice (Prof Graham Ogden and Dr Simon
Shepherd, Dundee Dental School) and brief interventions delivered by mobile phone and peer support
(Prof Iain Crombie and Dr Linda Irvine, Dept of Public Health, University of Dundee)
7
References
1. NHS Health Scotland Monitoring and Evaluating Scotland’s Alcohol Strategy Final Annual Report
March 2016 http://www.healthscotland.com/documents/26884.aspx
2. http://www.royalvoluntaryservice.org.uk/news-and-events/news/older-peopple-gift-14billionhours-a-year-to-volunteering
3. Equality and Human Rights Commission, Is Scotland Fairer? The state of equality and human
rights 2015, 2016
4. Equality and Human Rights Commission, Growing Older in Scotland: health, housing and care,
University of Stirling , October 2015
5. Royal College of Psychiatrists;, Our Invisible Addicts, June 2011
6. http://www.shaap.org.uk/what-we-drink.html
7. http://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-bytheme/vitalevents/deaths/alcohol-related-deaths
8. Drink Wise, Age Well Programme Data (Glasgow Project)
9. ISD Scotland, Alcohol-related Hospital Statistics Scotland 2014/15, October 2015
10. Households Below Average Income 2013/14, Chapter 6, DWP, 2015
11. Age Scotland Alcohol and Dementia Factsheet 2016
12. Life Changes Trust and Joseph Rowntree Trust, Scottish Social Attitudes (SSA) survey, June 2015
13. ILC-UK, Drink Wise, Age Well Alcohol and the Over 50s State of the Nation Report, January
2016 http://www.drinkwiseagewell.org.uk/wp-content/uploads/2016/01/Drink-Wise-AgeWellAlcohol-Use-and-the-over-50s-Report-2.pdf
14. Social Care Institute for Excellence, Preventing loneliness and social isolation among older
people, 2015
15. IRISS, Preventing loneliness and social isolation in older people, Insight 25, 2014
16. Centre for Ageing Better (Ipsos MORI) Later life in 2015: An analysis of the views and experiences
of people aged 50 and over, 2015
17. S Wadd, K Lapworth, M Sullivan, D Forrester, S Galvani; Working With Older Drinkers, University
of Bedfordshire, August 2011
8