GLOBAL HEALTH AGING

Risky drinking – defined as drinking at levels that put a person at risk of medical or social problems – has for centuries been viewed as an affliction of youth and immaturity. Yet, as the first wave of baby boomers reach retirement age, a startling trend is revealing itself: older adults are now drinking more than any previous cohort of retirees, with over 40 percent of older drinkers in some Western countries being classified as ‘hazardous drinkers.’

Our international research team recently explored patterns of drinking in older populations in nine different countries, including the United States, England, New Zealand, China, Mexico, Russia, Ghana, South Africa, and India. These countries span different political approaches, distinct continents, and various development levels, and the results were startling.

Drinking in older adults appears to be closely tied to wealth. We found that the proportion of older adults that drink is much higher in Western countries (e.g., the U.S., England and New Zealand) than non-Western countries. Additionally, while evidence shows that older men are more likely to drink than older women, this disparity is far smaller in Western countries than it is in non-Western countries.

There are three key reasons why rising rates of drinking among older adults should spark international concern.

1. Aging increases the risk of alcohol-related harm: Alcohol use merely is much riskier for an older adult than it is for a younger adult. The physiological aging process reduces our ability to process and detoxify alcohol, meaning we are more sensitive to its effects as we age even at the same level of consumption. Combined with this rising sensitivity to alcohol, aging itself also raises the risk of alcohol-related harm. As we age we are more likely to develop chronic conditions associated with (or exacerbated by) alcohol use or use medication that alcohol may interfere with, and to experience symptoms (e.g., nausea, sleeplessness, frailty, falls, depression) that alcohol can make worse. Unsurprisingly, older adults are far more likely to experience alcohol-related injuries and mortality than younger age groups.
2. Older drinkers are neglected: Despite being at a heightened risk of alcohol-related harm, older drinkers are very likely to remain undetected in our communities. Research shows that older adults are much less likely than younger adults to be screened for alcohol use by health professionals. Furthermore, health conditions potentially underpinned by alcohol use are often misattributed to the aging process. Lastly, a recent report titled ‘Calling Time’ by Dr. Sarah Wadd and the British organization Drink Wise Age Well illustrates consistent neglect of older adults in alcohol policy, research on alcohol trends and harms, and availability of alcohol and addiction services.
3. There are no benefits of drinking for older adults: A long-held assumption is that alcohol may be beneficial to heart health, and many older drinkers consume alcohol based on this belief. However, a growing body of international research now shows that the assumed health benefits of alcohol use were the result of poorly analyzed data and that there are no health benefits of drinking for older adults.

Unfortunately, our current health systems are ill-equipped to cope with this trend: in an era of rapid population ageing, a wave of older adults drinking at risky levels places considerable pressures on current health systems. Alcohol is the principle choice of drug for the ageing population and, although many do not meet the criteria for a substance use disorder, a large proportion will still require intervention to address the adverse consequences of excessive alcohol consumption (REF: Savage). Indeed, the number of older adults requiring substance misuse treatment services in the United States alone was expected to triple in the first two decades of this century (REF: Gfroerer). Given a rising rate of risky drinking despite the increased risk of harm and reduced likelihood of detection by health professionals, it is little wonder that the UK Royal Society of Psychiatrists now refers to older drinkers as ‘our silent addicts’.

What can we do? Fortunately, there is one key way in which we can collectively help mitigate this public health challenge.  As former American supreme court justice, American Lawyer Louis D. Brandeis (1856-1941) once said “Publicity is justly commended as a remedy for social and industrial diseases. Sunlight is said to be the best of disinfectants.” This sums up the critical issue here: many older drinkers are just unaware of their risk levels because society does not realize that there is an issue to address. We have the evidence that shows many older adults are now drinking hazardously, despite the risks this poses, so now it is up to each of us to start talking to friends, family members, colleagues, health professionals and policymakers about it.

Dr. Andy Towers is a senior lecturer in the School of Health Science at Massey University (New Zealand). His teaching and research focus primarily on alcohol and drug use trends, policy and outcomes. In conjunction with colleagues at the University of Auckland (New Zealand), he leads a collaboration of researchers from the United States, Europe and the World Health Organisation in an international study of the global prevalence of older adults drinking patterns and health-related outcomes.