Cheers! The truth about problem drinking
The stories about office parties spiralling out of control are already trickling through. Next will be the features about hangover cures and the annual drink-drive ads of cars driven by sozzled youngsters ploughing over picnickers or else plunging into lakes.
The climax of what will be a self-righteous orgy of condemnation will be the double page spreads we can look forward to on New Years Day collected from all the major cities across the UK of young people sprawled out in pools of their own vomit and punching ambulancemen on their way to A&E.
All this will serve to increase the perception that excess drinking is a curse of the young and the annual media coverage helps to explain why policy initiatives are directed at that age group.
However, scientific research – as opposed to the news - tells us that drinking amongst younger people is declining.
Meanwhile problem drinking amongst older people continues to rise almost unnoticed, until now. The trouble is that much of it takes place at home, behind closed curtains. It is a secretive, hidden syndrome – and the evidence for it is buried in bottle banks not strewn across the pavements of our cities.
The Big Lottery is supporting a £25 million UK-wide initiative - Drink Wise, Age Well - which sets out to gain a greater understanding of the scale of the issue and how best to help older people better control their drinking.
Phase one was to carry out a survey of people over 50, examining their drinking patterns and the reasons why they drink. Astonishingly this is the first survey of its kind to be undertaken anywhere in the world.
The learnings are being used to develop effective programmes in five areas across the UK which will then be benchmarked against five similar control areas.
The survey results cast serious doubt over the efficacy of current official anti-alcohol campaigns on older people and suggest a widespread lack of understanding of the particular circumstances that can lead older people to become more vulnerable to alcohol.
One of the more disturbing aspects of this is the number of older people who do not know what the recommended limits for alcohol are. Nearly three quarters of respondents cannot correctly identify the recommended drink limits and almost 2 in 5 respondents are not confident that they can calculate alcohol unit.
Perhaps this is a reason why 18% said they had driven within an hour of taking alcohol in the past year with 4% of respondents believing they might have been over the limit.
The second phase of the project will identify the best means of getting the message across to older people.
Joanne Smith is managing the programme for the Western Trust area in Northern Ireland she says that experience is showing that for older people it is best to avoid scaremongering.
“In our work we are trying to present the facts to older people, giving them the statistics and relaying the positive message around success rates for people wanting to tackle drinking problems. “
A more nuanced, fact-based approach might also help to alleviate some of the negative coverage received by the press around the alleged emergence of a “nanny state.”
This is also often evident at this time of year. Middle class broadcasters and print journalists are often no strangers to drink and tend to see the consumption of a few glasses of white wine in front of the Aga in a rather different light to drinking cider on the street. They see the splinter in young peoples’ eyes without noticing the plank in their own. The media can therefore be part of the problem in addressing drinking problems in older people.
Essential to effectively communicating with the demographic, is getting a strong understanding of some of the factors that affect drinking in that age group.
Part of this will involve explaining to older people the specific risks that alcohol poses to them as the ageing process impacts both mental and physical functions.
Treatment for high levels of drinking carries a stigma and, quite understandably, many older people are reluctant to attend clinics or even seek help even when they need it. Joanne and her colleagues address that by offering one-to-one support and meeting up with clients in their own homes, or other venues where they feel comfortable.
Not surprisingly higher-risk drinkers are much more likely to experience problems with either mental or physical health. People who say they are experiencing emotional problems are four times more likely to be in the higher-risk category than those who are not, and people who report either being limited in daily activities due to physical health problems or else are living with pain are twice as likely to be in the high-risk group than those who are not.
This brings in some issues that often effect older people: bereavement, retirement, loss of employment, loneliness and isolation and the impact of physical illness and pain management.
The biggest factor of all is not being able to cope with the stresses of life and, the survey points to loneliness and isolation being a key factor in high-risk drinkers.
Joanne said: “Key to helping this is to offer social activities, we run six week programmes offering a range of things that people can do: fishing, cycling, yoga, you name it. This can help people regain a social life and integrate back into the community.”
Volunteers are also being recruited to help identify people at risk and encourage them back into community life.
The findings suggest that helping to deal with the issue will involve much more than telling people to cut down on drinking, it will also involve interventions to help deal with the problems that lead to the mental and physical health problems.
There are also other factors that exacerbate drinking risks for older people. Not least of these is that as we age our ability to metabolise alcohol is reduced, so that in crude terms we get more drunk for longer as we get older.
The survey reports specific concern about what it calls the “oldest old”, defined as those over 85. It states: “Whilst health professionals, service providers and policy makers arguably do not give sufficient attention to older adults of any age, there is particular danger of this happening with the ‘oldest old’.”
This is because they tend to be frail or disabled, increasing the risk of not being able to attend appointments and being at greater risk of falls. Many too are acting as unpaid carers, others have dementia and a high percentage are in residential homes.
Clearly there are specific difficulties in providing information and support to the oldest old and no evidence to date that the authorities are factoring this in. This problem will be getting attention in phase two of the Drink Wise, Age Well programme.
It’s not just older people themselves who will need help to address the problem. The survey concludes that a lack of awareness amongst health professionals can lead to symptoms being missed: “There is the danger that alcohol-related harm in older adults is not being detected, with symptoms being attributed to delirium, age-related cognitive impairment or side-effects from medication.”
Some detox services have a cut off age of 65 which many observers will find baffling.
The programme hopes to build on some pioneering work that is already taking place. Older Focus, for example, which is part of Addiction NI is the first specialist alcohol treatment service for the over 50s in Northern Ireland. It has compiled specific information leaflets and carries out appointments in peoples’ homes. Results to date have been impressive.
Helping to educate and inform health professionals about the specific impacts of alcohol on older people will be another focus of the next phase of the programme.
Over the course of its life Drink Wise, Age Well aims to transform our understanding of the hidden problem of older peoples’ drinking, to develop interventions that work and to permanently change public policy.
It is a partnership between Addaction, Addiction NI, Drug and Alcohol Charities, Wales, the International Longevity Centre, the Royal Voluntary Service and the University of Bedfordshire.
Let’s hope that its work and the importance of helping older problem drinkers is not lost in the inevitable frenzy of alcohol-related news coverage this Christmas.
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