Policy Implications of drinking in later life

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Policy Implications of drinking in later life
Dr Tony Rao Consultant Old Psychiatrist
and Visiting Researcher South London and
Maudsley NHS Foundation Trust and Institute
of Psychiatry
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Interpreting causality between health and
drinking in later life Older people moderate
their drinking over their life course if their
health declines, thereby introducing selection
bias in the remaining drinkers Sick Quitters
may have determined cohort of older people at
Wave 5 ELSA study finding is that drinking in
later life confers no additional health
benefits Abstainers in ELSA study were more
likely to experience an improvement in health
when compared with continuing drinkers
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Drinkers in later life A selective super
healthy at-risk group?
ELSA study finds greater likelihood of
increased drinking in older people who are well
educated and have high wealth Implications for
effective communication of public health messages
that risky drinking behaviour may predict poor
health in oldest old
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Partnership matters

• Different consequences of losing a partner in men
  and women
• ELSA Study highlights partnership as protective
  factor in men
• There may be plausible reasons for reduction in
  drinking following
• loss of partner in women
• Better social engagement
• Loss of habit of drinking as drinking partner
• More likely to be prescribed benzodiazepines

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Nanny State or Public health
Dr Bully wants to snatch grannys sip of
sherry No doubt there are geriatric problem
drinkers but that does not justify this
puritanical mass bullying
When Jeanne Calment of Arles reached her 117th
birthday in 1992, a local paper reported that she
was being pressed by those in her nursing home to
give up cigarettes though she smoked only one
or two a day and port, which she loved. I was
reminded of that hateful story last week, when
the Royal College of Psychiatrists announced that
people over 65 are drinking far more than is good
for them, and that each day women should restrict
themselves to a small glass of wine and men to
less than a pint of average-strength pub beer
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Trends in Drinking Patterns in Older People
General Lifestyle Survey (ONS, 2013) Between
2005 and 2013, percentage of men drinking 8 or
more units of alcohol on any one day in past week
reduced by 5 in 65 age group 12 in 45-64 age
group 19 in the 25-44 age group 30 in the
19-24 age group
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Older Drinkers- A Growing Public Health Burden
Over 65 age group more likely to drink on 5 or
more days of the week Between 2000 and 2012,
percentage of men and women in England drinking
over recommended limits increased by 50 and 100
respectively Number of people aged 65 and over
admitted to hospitals in England for alcohol
specific disorders has increased by 40 over the
past 6 years In 60 age group and over, hospital
admissions in England for mental and behavioural
disorders associated with alcohol use outnumber
those with alcohol related liver disease.
Number of people aged 60 and over admitted to
hospitals in England with alcohol related brain
injury has risen by over 140 over the past 10
years, with an almost static rise in the 15-59
age group Population of aged 65 age group and
above in England and Wales increased by only 11
between 2001 and 2011
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Obstacles to effective communication of public
health messages
  Scandinavian drinking culture still exists in
the UK Rationalisation such as never did my
dad any harm Understanding alcohol as a
drug Risky drinking patterns vs Total amount
consumed Under-reporting Health risks not
always causal
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A Fourth Age The Oldest Old
Some evidence that older drinkers in their 70s
and 80s continue to drink into their
90s Number of people aged 90 in England and
Wales accounted for 1 of the population in
2011 Oldest Old population has increased by 26
since 2002 and will continue to rise
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The Bigger Picture of Healthy Drinking
Cognitive disorders StrokePsychosis Depression
Head, Neck, GI cancers
Neuropathy Anaemia Nutritional Deficiencies
Coronary Artery Disease CardiomyopathyArrhythmia
Hypertension Stroke
Liver Disease Cirrhosis
Stomach ulcer Gastritis
Pancreatitis Diabetes
Duodenal ulcer