When we think about who experiences harm caused by alcohol, most people think about young people. However, Australian data show the rate of risky drinking among young people has been decreasing, while risky drinking among older adults has been increasing.
The consumption of cannabis shows a similar trend. This is of significant concern since older adults are at elevated risk of alcohol-related harm.
Why are older drinkers more at risk?
The Australian government has specific guidelines for the general population to minimise the potential of alcohol-related harm. However, these guidelines simply recommend that older adults drink less. This is because there is a lack of specific research to indicate more precise levels for low-risk drinking among older people.
Older adults are at increased risk of experiencing alcohol-related harms for three main reasons.
First, with age, the body becomes less effective at metabolising alcohol. This means alcohol has a more potent impact on an older person compared to a younger person consuming the same amount of alcohol. In turn, this increases the likelihood of injury and falls among older people who drink.
Second, older adults are more likely to be taking a range of medications that can interact with alcohol and cause an adverse drug event. A recent study found that 60% of drinkers were taking at least one medication that could adversely react with alcohol. Many of these medications can severely interact with alcohol. For example, drinking alcohol while taking certain blood-thinning medications could cause increased risk of death from haemorrhaging.
Third, older people are likely to experience health conditions that can be exacerbated by the effects of alcohol. For example, high blood pressure and heart disease can be more difficult to treat when a person drinks alcohol. In addition, alcohol is a known carcinogen. As such, it is recommended that cancer survivors abstain from alcohol and that alcohol consumption be minimised to avoid the risk of developing various forms of cancer.
While some older people who experience alcohol-related problems have been heavy drinkers for much of their life, there are others whose previously moderate drinking escalates with age.
Various events associated with ageing can precipitate the onset of problems associated with alcohol. Such events include loss of identity associated with retirement, more free time and less responsibility. Some older people’s drinking escalates as a result of grief associated with losing a loved one, or inability to engage in activities due to health conditions, or loneliness and isolation.
The role of health-care professionals
Australia’s drinking guidelines suggest that each older adult should seek advice from their GP about what constitutes a safe drinking limit for them that takes into account all of the risks. However, most older adults don’t know about these risks. They are therefore unlikely to seek such advice from their GP.
Conversely, many health-care professionals are reluctant to ask older people about their use of alcohol and other drugs. Most don’t think that the lovely old lady or gentlemen that they see might have a problem with alcohol. Even if concerned, they may feel embarrassed to ask them about their substance use.
Not asking about drinking patterns and levels can result in health-care professionals treating what they believe to be the symptoms of a medical problem, when in fact the symptoms are related to the use of alcohol or other drugs.
To support health professionals to navigate this delicate area, we have published Australia’s first guidelines for health professionals. This provides the necessary skills to assess older adults’ use of alcohol and other drugs.
We hope health-care professionals will now be better able to identify older adults at risk of experiencing alcohol-related harm and provide appropriate advice and support. We also hope more older adults will be referred for specialist treatment to address their use of alcohol and other drugs.
Treatment services
Older adults are less likely to engage with traditional treatment services, such as counselling and rehabilitation. They may perceive such services to be for younger people, or lacking mobility access or an appropriate atmosphere.
Many other countries such as Canada, the United States and the Netherlands have developed services specifically for older adults. However, in Australia there is currently only one older-adult-specific treatment service.
The guidelines we have published will assist other treatment services to implement older adult-specific services. We hope this will lead to more such age-specific treatment in Australia.
Stephen Bright is affiliated with Peninsula Health’s Older Wiser Lifestyles (OWL)
Ann Roche is Professor and Director of the National Centre for Education and Training on Addicition (NCETA), Flinders University and receives funding from the Australian Government Department of Health and Ageing.