Transcript Policy Implications of drinking in later life

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
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
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’
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
‘Nanny State’ or Public health
Dr Bully wants to snatch granny’s 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
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
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
Alcohol related deaths 1991-2012 in UK per 100,000 population
50.0
Adapted
from data
from the
Office for
National
Statistics
licensed
under the
Open
Government
Licence v.2.0.
45.0
40.0
35.0
30.0
25.0
15-34
35-54
20.0
55-74
15.0
75+
10.0
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
0.0
1991
5.0
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’
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
The Bigger Picture of ‘Healthy Drinking’
Cognitive disorders
Stroke
Psychosis
Depression
Neuropathy
Anaemia
Nutritional Deficiencies
Liver Disease
Cirrhosis
Pancreatitis
Diabetes
Head, Neck, GI cancers
Coronary Artery Disease
Cardiomyopathy
Arrhythmia
Hypertension
Stroke
Stomach ulcer
Gastritis
Duodenal ulcer