Alcohol-deaths in Scotland’s Ageing Population – a priority for prevention

By fionab | Posted 03.08.2017

The National Records for Scotland have published worrying  figures that show there were 1,265 alcohol-related deaths in 2016 — an increase of 115 (10%) compared with 2015, and the highest annual total since 2010. However broken down these figures show that our ageing population show the most significant increases, and the number of deaths in the over 75s was the highest number ever recorded for that age-group. The number of deaths for the  60-74 year old age group was  468,  a third consecutive increase, and the highest for that age-group since 2006. The highest number of alcohol-related deaths occurred in the 45-59 age-group.

Consumption levels in our older population have also been increasing, however it is important to point out that most often alcohol-related harm is the accumulated result of years of alcohol misuse and the full effect of changes in consumption are not immediately apparent in harm data. Whilst there has been a 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[1] report shows those aged 45-54 and 55-64 consume more alcohol per week than other age groups. 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.

Drinking in an older population can also be more hidden. For three quarters of Scots, the most common drinking location is the home and this proportion increases with age [2]. 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.

Other factors also make our ageing population more vulnerable to alcohol-related harms;

  • Older adults can have a reduced ability to metabolise and excrete alcohol making them more vulnerable to the harmful effects even at low levels of use.
  • Alcohol can exacerbate or accelerate the onset of conditions which are associated with ageing (e.g. cognitive impairment, falls).
  • Older adults may be more likely to conceal alcohol misuse and less likely to ask for help because of high levels of shame and embarrassment and generational differences in terms of pride and disclosure of personal problems.
  • Older adults may have different motivations for pursuing healthier behaviours e.g. maintaining independence and cognitive functioning.
  • Older adults are more likely to drink every day
  • Losses, life changes and transitions associated with ageing can result in isolation, loss of independence, loneliness and psychological distress and may contribute to some people starting, recommencing or escalating alcohol misuse in later life.
  • Older adults may have fewer or less active social roles (e.g. no longer employed, not raising children) therefore their alcohol misuse may be more likely to escape notice.
  • Older adults may have extensive histories of alcohol misuse, multiple and complex needs and failed treatment attempts.
  • Older adults may find it difficult to access alcohol services (e.g. due to decreased mobility, service design ).

Our ageing population is increasing. A 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[3] . The Invisible Addicts Report (2011) states that “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[4].

The Scottish Government has globally led the way in reducing alcohol related harm in the Scottish population through our national alcohol strategy. However it is also crucial that in Scotland our policy and practice in relation to alcohol-harm addresses the needs of our ageing population. Whilst policy approaches such as Minimum Unit Pricing will undoubtedly reduce alcohol harm at a population level, particularly for our most harmful drinkers, it is imperative that effective strategy doesn’t follow a ‘one size fits all’ approach. We must adopt targeted approaches for different segments of the populations, depending on people’s needs and level of risk. The current Alcohol Strategy rightly recognises the vulnerabilities of our younger population however does not include the needs of older adults in any of its measures or recommendations. We have seen some positive strides with our colleagues in Wales and Northern Ireland, with both alcohol strategies recognising older adults as a distinct group who require targeted approaches. Recently the Welsh Government’s Advisory Panel on Substance Misuse has also published a report, ‘Substance Misuse in an Ageing Population’ which explores best practice and strategic responsibilities.  Drink Wise, Age Well continues to advocate across each country for stronger recognition of the needs of our ageing population in relation to reducing alcohol-related harm.

If older adults were at very low risk of the negative consequences of alcohol, perhaps giving older adults little or no attention in alcohol strategy might be justified.  However, this is not the case, older adults are a high-risk group in terms of alcohol use and related harm and we would welcome the opportunity to support the Scottish Government to address the specific needs of our older population.

 

[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.shaap.org.uk/what-we-drink.html

[3] Equality and Human Rights Commission,   Growing Older in Scotland: health, housing and care, University of Stirling , October 2015

[4] Royal College of Psychiatrists;, Our Invisible Addicts, June 2011