Reducing Alcohol-Related Harm in Older
People: A Public Health Approach
Sarah Wadd
March 2014
Public Health Approach to
Prevention
Surveillance:
What is the problem?
Implementation:
Scaling up effective
policy and programmes
Identify risk and
protective factors:
What are the causes?
Develop and evaluation
interventions:
What works and for
whom?
What is the extent of the problem?
• 1.4 million older people exceed
drink limits.
• More than half a million alcohol
related hospital admissions each
year.
• More likely to be admitted to
hospital or die from alcoholrelated problem.
• Levels of harm increasing fastest
in this age group.
• Drink driving prosecutions
increasing.
The time to act is now
What is alcohol prevention?
• Preventing new alcohol problems
developing.
• Providing interventions and
treatment for hazardous, harmful and
dependent drinkers.
• Reducing harm in people unable or
unwilling to reduce/stop drinking.
Is it worth it?
• 1 in 3 alcohol problems in older people
develop in later life.
• Many alcohol-related harms are reversible.
• Older people more likely to be treated
successfully.
• Even those with long history of misuse can
change.
• Prevention much cheaper than dealing with
consequences alcohol-related harm.
National Policy
•
•
•
•
•
•
Regulating physical availability
Taxation and pricing
Drink driving
Treatment and early intervention
Controlling the promotion of alcohol
Education and persuasion
Why do Older People Require
Special Consideration?
• Have unique vulnerabilities.
Vulnerability to Alcohol-Related Harm
Alcohol produces a
more rapid depressant
effect on brain and
older people are
particularly sensitive to
the toxic effects of
alcohol on the brain
Activity of the enzyme
alcohol
dehydrogenase, which
breaks down alcohol is
significantly reduced.
There is decreased
blood flow to the liver
Muscle is replaced by
body fat as people age.
Alcohol is not drawn
into body fat as well as
it draws into muscle,
therefore, blood alcohol
concentration is higher
in older people
Older people are
more susceptible to
imbalance after
acute alcohol
ingestion making
them susceptible to
falls. More likely to
be experience a
fracture if they fall.
Why do Older People Require
Special Consideration?
• Have unique vulnerabilities.
• Drink in different ways.
• Have different risks and
protective factors.
Risk and Protective Factors
•
•
•
Attitudes towards older
people
Social capital
Societal attitudes towards
alcohol
Society
•
•
•
•
•
•
•
•
•
Community/
Environment
Activities for older people
Transport
Sense of safety
Community norms
Availability of alcohol
Health and social services
Alcohol services
Residential care
Deprivation
•
•
•
•
Retirement
Unemployment
Occupational socialisation
Drinking culture
Work
•
•
•
•
•
•
•
•
•
ReR
Relationships
•
•
•
•
•
•
Personal attitudes
Knowledge
Coping skills/resilience
Chronic pain, insomnia
Time & opportunity to drink
Disability
Mental health
Cognitive impairment
Financial circumstances
Individual
Bereavement
Loss of friends
Family conflict/relationship breakdown
Being carer
Family attitudes towards drinking
Elder abuse
Wadd, 2014
Risk and Protective Factors
•
•
•
Attitudes towards older
people
Social capital
Societal attitudes towards
alcohol
Society
•
•
•
•
•
•
•
•
•
Community/
Environment
Activities for older people
Transport
Sense of safety
Community norms
Availability of alcohol
Health and social services
Alcohol services
Residential care
Deprivation
•
•
•
•
Retirement
Unemployment
Occupational socialisation
Drinking culture
Work
•
•
•
•
•
•
•
•
•
ReR
Relationships
•
•
•
•
•
•
Personal attitudes
Knowledge
Coping skills/resilience
Chronic pain, insomnia
Time & opportunity to drink
Disability
Mental health
Cognitive impairment
Financial circumstances
Individual
Bereavement
Loss of friends
Family conflict/relationship breakdown
Being carer
Family attitudes towards drinking
Elder abuse
Why do Older People Require
Special Consideration?
• Have unique vulnerabilities.
• Drink in different ways.
• Have different risks and
protective factors.
• Have different attitudes,
values and beliefs.
“I just like the one-to-one [therapy]. I
am very afraid of going into a crowd
[group therapy].…..I think because it
is a personal problem there is a
terrible shame about it....I’m not
having to share the shame with lots
of people. It is terrible, terrible
shame.”
(Wendy, 73, early-onset)
Why do Older People Require
Special Consideration?
• Have unique vulnerabilities.
• Drink in different ways.
• Have different risks and
protective factors.
• Have different attitudes,
values and beliefs.
• Have different levels of
knowledge
Percentage of Respondents who had
heard of Alcohol Units
100
90
80
76
Percentages
70
60
16-24
56
25-44
50
45-64
40
65 and over
30
20
10
0
1997
1998
2000
Source: Omnibus Survey, 1997-2008
2002
2004
2006
2007
2008
Why do Older People Require
Special Consideration?
• Have unique vulnerabilities.
• Drink in different ways.
• Have different risks and
protective factors.
• Have different attitudes,
values and beliefs.
• Have different levels of
knowledge
• Face different barriers.
Professional Barriers
• Lack of awareness that alcohol misuse is a
potentially important problem for older people.
• Reluctance to ask embarrassing questions of
older people.
• Attitude that older people are too old to change
their behaviour.
• Belief that it is wrong to ‘deprive’ older people
of their ‘last pleasure in life’.
• Inability to identify signs and symptoms of
alcohol problems in older people.
Why do Older People Require
Special Consideration?
• Have unique vulnerabilities.
• Drink in different ways.
• Have different risks and
protective factors.
• Have different attitudes,
values and beliefs.
• Have different levels of
knowledge
• Face different barriers.
• Have different motivatiors.
Motivators for Older People
• Staying healthy and
independent.
• Sleeping better.
• More energy to go out
and socialise.
• Improved memory.
• Save money.
• Less likely to fall.
Preventing New
Alcohol Problems
• Increasing understanding of
alcohol units.
• Improving coping skills in
carers.
• Providing bereavement
counselling.
• Providing activities and
opportunities to socialise.
Providing Age-Appropriate
Interventions and Treatment
• Advice on alcohol and
medication interactions.
• Brief interventions which focus
on motivating factors for older
people.
• Alcohol services which are
culturally appropriate for older
people.
• Alcohol treatment at home.
Harm Reduction
• Address trip and fire
hazards.
• Ensure they are eating
properly.
• Assess risk of elder abuse.
• Consider thiamine therapy
for heavy drinkers.
sarah.wadd@beds.ac.uk