Alcohol deaths in Scotland’s ageing population – a priority for prevention

Julie Breslin
Buchanan Street, Scotland

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, when 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.

Consumption levels in our older population have also been increasing, but it's 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 among 16-24 year olds, there has been little or no reduction in older age groups.

A 2016 Monitoring and Evaluating Scotland's Alcohol Strategy (MESAS) report shows that people 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 - but the proportion of 65-74 year olds exceeding drinking guidelines increased.

Drinking in an older population can also be less easy to spot or monitor. For three quarters of Scottish people, the most common drinking location is the home. This proportion increases with age. At home, measures are often freely poured, so it is difficult to know how much is being consumed, or whether this is within recommended guidelines. Data 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 harmful effects even at low levels of use
  • Alcohol can exacerbate or accelerate the onset of conditions which are associated with ageing (such as cognitive impairment and falls)
  • Older adults may be more likely to conceal alcohol misuse and less likely to ask for help. Shame and embarrassment can play a part, alongside generational differences in terms of pride and how comfortable people feel disclosing personal problems
  • Older adults may have different motivations for pursuing healthier behaviours, such as 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. These may contribute to some people starting, recommencing or escalating alcohol misuse in later life
  • Older adults may have fewer or less active social roles (for example, they may no longer be employed or raising children) so 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 (they may experience decreased mobility or services may not have been designed to meet their needs).

Our ageing population is increasing. A European Commission for Human Rights report, Growing Older in Scotland: Health, Housing and Care, 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. People are living longer and larger numbers of people are turning 50. 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 on to 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.

The Scottish Government has globally led the way in reducing alcohol related harm in the Scottish population through a 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 population, depending on people’s needs and levels of risk.

The current Alcohol Strategy rightly recognises the vulnerabilities of our younger population, but does not include the needs of older adults in any of its measures or recommendations. We have seen our colleagues in Wales and Northern Ireland making positive strides, 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.

About Drink Wise, Age Well

Drink Wise, Age Well is a partnership led by Addaction which includes Royal Voluntary Service, the Substance Misuse and Ageing Research team (SMART), Glasgow Caledonian University and the Scottish Drug Forum.

With support from the Big Lottery Fund, the partnership delivers services in five demonstration sites across the UK. £4 million has been invested in our Glasgow site over a seven year period. We deliver a community-based, integrated programme offering prevention and awareness raising interventions, direct support to people and their families affected by alcohol use, resilience interventions and workforce development.

Drink Wise, Age Well aims to help people make healthier choices about their drinking as they age. We also support health and social care providers and community organisations to recognise and respond to problem drinking in the 50+ age group.