Research focus

Australia has a rapidly ageing population. The number of people aged 65+ is projected to more than double, to 8.8 million, in the next 40 years. Today’s older Australians have substantially different lifestyles and expectations compared to previous generations. This includes significant changes in alcohol-related attitudes and behaviours, raising previously unseen healthcare challenges.

To-date, limited research has been undertaken on the changing patterns of alcohol use among older Australians.

To address this gap, NCETA is undertaking an ongoing program of work to explore the increase in risky drinking levels and associated alcohol-related harms in older Australians.

Recent findings from this program of work will be presented by NCETA’s Nathan Harrison and Victoria Kostadinov at the Australian Public Health Conference, in Adelaide on 17-19 September 2019. 

Background

Risky drinking among Australian adults aged 50+ increased significantly between 2004 and 2016 [1]. This increase in risky alcohol consumption by older people is in stark contrast to the significant decrease in risky drinking among people aged 12–24 years during the same period [2]. 

High alcohol levels in older age groups are associated with age-specific harms including falls and injury and increased risk of chronic disease, including cardiovascular disease and dementia [3].

Older people also have a reduced capacity to metabolise, distribute and eliminate drugs, which can lead to negative impacts from polypharmacy and adverse alcohol-medication interactions [4,5]. Adults who do not reduce their alcohol intake as they become older may be at greater risk, even though their intake has not changed [6].

While there is a diverse range of drinking patterns among older people, evidence indicates that alcohol use is often increased or initiated in later years. In part, this reflects changing life circumstances in relation to retirement, and patterns of socialising, social acceptability and alcohol availability [7,8].

The natural increase in night-time wakefulness in the over 65s can also encourage the use of alcohol to facilitate sleep, which can lead to increased rates of alcohol-related sleep disturbances in older adults [9]. In other instances, alcohol may be used to cope with negative life experiences such as bereavement, social isolation, or mental health problems [10]. 

Internationally, it is estimated that the number of older people with alcohol and other drug (AOD) problems, or requiring treatment for a substance use disorder, will have more than doubled between 2000 and 2020 [11].

What needs to be done?

Despite this worrying trend, there is currently little guidance on how to best address the unique needs of older age groups about their alcohol use, or to support health professionals and carers to assist prevention, early identification and intervention for problem drinking.

Opportunities to prevent and minimise risk from alcohol-related harms in older adults are often missed due to:

• Professional attitudes and treatment challenges, such as lack of knowledge around age-specific challenges and fewer precise screening tools
• Generational stigma and around drinking and lower awareness of risk
• Fewer opportunities for detection from family and friends due to smaller social networks in older age groups [12,13].

To facilitate early identification of problem drinking, educating health care professionals about patterns and drivers of alcohol consumption by older people should be a priority.

This includes a focus on the workforce development needs and effective responses of services involved in the provision of services to older people, e.g., GPs, aged care, and other health and community supports.

In addition, the AOD workforce will increasingly require enhanced understanding of the physiological and psychological impact of AOD use among ageing populations in future years.

Specifically, awareness of the needs and characteristics of older patients about alcohol consumption should be improved through professional development and where appropriate service system redesign. Age-appropriate resources and techniques for clinical practice (e.g., safe drinking guidelines and alcohol screening tools) are also required to encourage low risk drinking among more vulnerable groups of older people [1].

A more nuanced understanding of the alcohol-related views of older people, their families and direct support networks are also warranted to increase individual and community resilience. Gaining a comprehensive view of the meaning, context and value placed on alcohol by older people, and their perspectives of risk and decision making around alcohol use, is essential. 

The next steps

NCETA is undertaking an innovative program of work on preventing and minimising AOD-related harms in older people. Collaborative partnerships include the South Australian Health and Medical Research Institute’s (SAHMRI) Registry of Older Senior Australians (ROSA), community-based groups, GP networks and aged care providers.

Key research areas include:

• Secondary analyses of the patterns and correlates of AOD use by people aged over 50 using nationally representative datasets, such as the National Drug Strategy Household Survey (NDSHS) and ROSA database. Identification of national patterns and trends will guide development of effective, tailored response strategies for those at risk.
• In-depth, qualitative interviews and focus groups with older people, their families and those involved in the provision of healthcare, policy and various forms of support, about the role and functions served by alcohol. 
• Examination of AOD and aged care workers’ capacity to respond effectively to the increasing number of older clients with AOD issues, focusing on knowledge, skills, views, experiences. 
• Promoting appropriate information and education around effective management of alcohol and medications in older people.

This comprehensive, multicomponent program of work addresses a critical gap in the extant literature and will provide mechanisms by which to implement viable and sustainable supports to meet the needs of the growing number of older Australians.

The findings from this ongoing research program will:

• Assist the AOD, aged care and welfare sectors to identify strategies to minimise the risks of alcohol-related harm in older adults
• Improve healthcare service provision and community support
• Provide the first Australian evidence base to inform future research and policy.

References

1. Roche, AM & Kostadinov, V. (2019). Baby boomers and booze: we should be worried about how older Australians are drinking. Medical Journal of Australia, 1, 38-19.
2. Australian Institute of Health and Welfare. (2017). National drug strategy household survey 2016: detailed findings. Canberra: AIHW.
3. Crome, I, Dar, K, Janikiewicz S, et al. (2018). Our invisible addicts: first report of the Older Persons’ Substance Misuse Working Group of the Royal College of Psychiatrists. Second edition (College Report CR211). London: Royal College of Psychiatrists.
4. Foster, J, & Patel, S. (2019). Prevalence of simultaneous use of alcohol and prescription medication in older adults: findings from a cross-sectional survey (Health Survey for England 2013). BMJ Open 2019;9:e023730. doi:10.1136/bmjopen-2018-023730
5. Pretorius, RW, Gataric, G, Swedlund, SK, et al. (2013). Reducing the risk of adverse drug events in older adults. American Family Physician. 87, 331-336.
6. Nicholas, R. & Roche, AM. (2014). Alcohol and other drug use and healthy ageing: Patterns of use and harm among older Australians. Grey Matters Information Sheet Series. Adelaide: National Centre for Education and Training on Addiction. Flinders University.
7. Sacco, P, Burruss, K, Smith, CA, et al. Drinking behaviour among older adults at a continuing care retirement community: affective and motivational influences. Aging & Mental Health, 19, 279-289.
8. Dare, J, Wilkinson, C, Allsop, S, et al. (2014). Social engagement, setting and alcohol use among a sample of older Australians. Health and Social Care in the Community, 22, 524-532.
9. Okun, ML, Reynolds, CF, Buysse, DJ, et al. (2011). Sleep variability, health-related practices, and inflammatory markers in a community dwelling sample of older adults. Psychosomatic Medicine. 73,142-150.
10. Bareham KB, Kaner E, Spencer, LP, et al. (2018). Drinking in later life: a systematic review and thematic synthesis of qualitative studies exploring older people’s perceptions and experiences. Age and Ageing, 0, 1-13.
11. Gossop, M. (2008). Substance use among older adults: a neglected problem. Lisbon, Portugal: European Monitoring Centre for Drugs and Drug Addiction.
12. Gilson, KM. (2015). Risky drinking in older adults: towards better awareness and screening in clinical practice. Australian Clinical Psychologist, 2, 1-13
13. Haighton, C, Wilson, G, Ling, J et al. (2016). A qualitative study of service provision for alcohol-related issues in mid to later life. PLoS ONE 11(2):e0148601.