Reducing Alcohol-Related Harm in Older People: A Public Health Approach Sarah WaddMarch 2014

Public Health Approach to Prevention Surveillance: What is the problem? Identify risk and protective factors: What are the causes? Develop and evaluation interventions: What works and for whom? Implementation: Scaling up effective policy and programmes

What is the extent of the problem? 1.4 million older people exceed drink limits. More than half a million alcohol related hospital admissions each year. More likely to be admitted to hospital or die from alcohol- related problem. Levels of harm increasing fastest in this age group. Drink driving prosecutions increasing.

The time to act is now

What is alcohol prevention? Preventing new alcohol problems developing. Providing interventions and treatment for hazardous, harmful and dependent drinkers. Reducing harm in people unable or unwilling to reduce/stop drinking.

Is it worth it? 1 in 3 alcohol problems in older people develop in later life. Many alcohol-related harms are reversible. Older people more likely to be treated successfully. Even those with long history of misuse can change. Prevention much cheaper than dealing with consequences alcohol-related harm.

National Policy Regulating physical availability Taxation and pricing Drink driving Treatment and early intervention Controlling the promotion of alcohol Education and persuasion

Why do Older People Require Special Consideration? Have unique vulnerabilities.

Vulnerability to Alcohol-Related Harm Muscle is replaced by body fat as people age. Alcohol is not drawn into body fat as well as it draws into muscle, therefore, blood alcohol concentration is higher in older people Activity of the enzyme alcohol dehydrogenase, which breaks down alcohol is significantly reduced. There is decreased blood flow to the liver Alcohol produces a more rapid depressant effect on brain and older people are particularly sensitive to the toxic effects of alcohol on the brain Older people are more susceptible to imbalance after acute alcohol ingestion making them susceptible to falls. More likely to be experience a fracture if they fall.

Why do Older People Require Special Consideration? Have unique vulnerabilities. Drink in different ways. Have different risks and protective factors.

Risk and Protective Factors ReR Individual Relationships Work Community/ Environment Society Personal attitudes Knowledge Coping skills/resilience Chronic pain, insomnia Time & opportunity to drink Disability Mental health Cognitive impairment Financial circumstances Bereavement Loss of friends Family conflict/relationship breakdown Being carer Family attitudes towards drinking Elder abuse Retirement Unemployment Occupational socialisation Drinking culture Activities for older people Transport Sense of safety Community norms Availability of alcohol Health and social services Alcohol services Residential care Deprivation Attitudes towards older people Social capital Societal attitudes towards alcohol Wadd, 2014

Risk and Protective Factors ReR Individual Relationships Work Community/ Environment Society Personal attitudes Knowledge Coping skills/resilience Chronic pain, insomnia Time & opportunity to drink Disability Mental health Cognitive impairment Financial circumstances Bereavement Loss of friends Family conflict/relationship breakdown Being carer Family attitudes towards drinking Elder abuse Retirement Unemployment Occupational socialisation Drinking culture Activities for older people Transport Sense of safety Community norms Availability of alcohol Health and social services Alcohol services Residential care Deprivation Attitudes towards older people Social capital Societal attitudes towards alcohol

Why do Older People Require Special Consideration? Have unique vulnerabilities. Drink in different ways. Have different risks and protective factors. Have different attitudes, values and beliefs.

“I just like the one-to-one [therapy]. I am very afraid of going into a crowd [group therapy].…..I think because it is a personal problem there is a terrible shame about it....I’m not having to share the shame with lots of people. It is terrible, terrible shame.” (Wendy, 73, early-onset)

Why do Older People Require Special Consideration? Have unique vulnerabilities. Drink in different ways. Have different risks and protective factors. Have different attitudes, values and beliefs. Have different levels of knowledge

Percentage of Respondents who had heard of Alcohol Units Source: Omnibus Survey,

Why do Older People Require Special Consideration? Have unique vulnerabilities. Drink in different ways. Have different risks and protective factors. Have different attitudes, values and beliefs. Have different levels of knowledge Face different barriers.

Professional Barriers Lack of awareness that alcohol misuse is a potentially important problem for older people. Reluctance to ask embarrassing questions of older people. Attitude that older people are too old to change their behaviour. Belief that it is wrong to ‘deprive’ older people of their ‘last pleasure in life’. Inability to identify signs and symptoms of alcohol problems in older people.

Why do Older People Require Special Consideration? Have unique vulnerabilities. Drink in different ways. Have different risks and protective factors. Have different attitudes, values and beliefs. Have different levels of knowledge Face different barriers. Have different motivatiors.

Motivators for Older People Staying healthy and independent. Sleeping better. More energy to go out and socialise. Improved memory. Save money. Less likely to fall.

Preventing New Alcohol Problems Increasing understanding of alcohol units. Improving coping skills in carers. Providing bereavement counselling. Providing activities and opportunities to socialise.

Providing Age-Appropriate Interventions and Treatment Advice on alcohol and medication interactions. Brief interventions which focus on motivating factors for older people. Alcohol services which are culturally appropriate for older people. Alcohol treatment at home.

Harm Reduction Address trip and fire hazards. Ensure they are eating properly. Assess risk of elder abuse. Consider thiamine therapy for heavy drinkers.