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Alcohol and Ageing: The International Trends Worrying Health Researchers

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.

When we explored the patterns of drinking across countries, we found that older drinkers in Western countries also seem to drink more frequently than older drinkers in non-Western countries. However, we also found that frequent (2-3 days per week) or very frequent (4+ days per week) heavy drinking occurs in both Western or non-Western countries, as with China and South Africa show an alarming number of older adults consuming alcohol heavily.

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.

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Hong Kong plans for a city that’s growing older

Today, about 16 percent of Hong Kong’s population is age 65 or older. By 2064, that is expected to be 36 percent.
HONG KONG — For decades, this city of more than 7 million has been one of Asia’s most dynamic places, filled with a youthful energy that drove rapid growth in both the population and the local economy.

Planners here still see Hong Kong that way. But they also are looking at the long-term trends, and grappling with a force they cannot stop: Hong Kong is getting older. That’s true of both the city’s people and its built environment — a phenomenon planners here call “double ageing”.

Today, about 16 percent of Hong Kong’s population is age 65 and over. By 2064, that’s expected to be 36 percent — and one in ten residents will be over the age of 85.

Meanwhile, housing stock that appears middle-aged today will become outdated tomorrow. By 2047, some 326,000 private housing units will be more than 70 years old. Many of them feature long flights of stairs unfriendly to older people. More than a third of seniors live in public housing, but the two-year wait list is bound to grow longer as citizens age.

The double-ageing problem is just one issue that Hong Kong’s planners are trying to figure out as they write a comprehensive plan called Hong Kong 2030+. The plan aims to take future demographic and economic trends into account while charting a path for improving quality of life in one of the world’s most densely settled cities.

Phyllis Li Chi Miu, deputy director of the city’s territorial planning department, says buildings, roads, parks and public transport all will need rejuvenation to make the city age-friendly. “It’s a challenging task,” she says.

Alignment with New Urban Agenda

Planners are also looking at how they can align the 2030+ plan with the New Urban Agenda. That’s the 20-year plan for sustainable urbanization that nations agreed to last October at the U. N.’s Habitat III conference in Quito, Ecuador.

Alignment was the main topic of conversation at a recent “Urban Thinkers Campus” conference here. At the event, Li noted that the 2030+ plan already stresses key elements of the New Urban Agenda such as social inclusion and environmental protection.

However, there was some debate about the New Urban Agenda’s relevance in the context of a city-state like Hong Kong. Paul Zimmerman, an environmentalist and elected councilor, said that some notable issues mentioned in the New Urban Agenda, such as increasing numbers of cars on the road, growth of slums and poor utility services, are not problems in Hong Kong.

“Hong Kong is a city and also a country,” Zimmerman said. “It’s a city in which hyper-density and wilderness co-exist. Other mega-cities have no space in their periphery, while Hong Kong has a massive open space in its periphery.”

However, Professor NG Mee Kam of the urban studies programme at the Chinese University of Hong Kong, told Citiscope that the 2030+ plan “needs to strongly align with the New Urban Agenda to plug in crucial policy gaps.” For example, she said, Hong Kong’s plan could take a cue from the New Urban Agenda’s focus on the informal sector and the importance of cultural heritage.

Retrofitting and reclaiming

The 2030+ plan proposes three “building blocks” for implementation — planning for a liveable high-density city, embracing new economic challenges, and creating capacity for sustainable growth.

A major focus, particularly when it comes to dealing with the double-ageing problem, is retrofitting districts with the most old buildings. Tall buildings are likely to be renovated, while many smaller buildings will likely be demolished to make way for new construction and open space. Retrofitting public spaces is also a priority. The city intends to add curb-cuts at sidewalks to make it easier for seniors to walk, and aims to increase the amount of public space from 2 square metres per person to 3.5 square metres.

The plan also aims for compact urban growth that is highly integrated with public transport. Homes and offices are to be within 200 to 300 metres of transit; open spaces within 400 metres; and community facilities, railway stations and educational institutes within a range of 500 metres.

“We are looking at optimum land use through retrofitting,” Li said.

The plan also envisions reclaiming a good bit of land from the sea. That’s a strategy that Hong Kong has long relied on to create room for the city to grow — the city’s airport and Hong Kong Disneyland resort are both located on reclaimed land.

Under the 2030+ Plan, Hong Kong would add another 4,800 hectares (nearly 12,000 acres) of land — a little less than the area of Manhattan. The land would be used for housing, industry, transport facilities and open space. These would include a few large urban extensions such as the East Lantau Metropolis, which is to be home to as many as 700,000 people.

Work on the 2030+ plan started in 2015 and is in the fourth of six phases of public consultation. The final plan is expected to be released next year.

What can a simple fruit fly teach us about ageing?

A recent study could lead to interventions that extend human lifespan and improve health in our later years. Based on new evidence regarding a DNA-based theory of ageing, this field aims to attenuate diseases of ageing such as cancer, hypertension and Alzheimer’s disease.

Ageing research dates back many years, but thanks to scientists at the Buck Institute for Research on Aging the field has become more widely recognised. Researchers at Buck coined the term ‘geroscience’ to explain the relationship between ageing and age-related diseases. The notion that people are more susceptible to diseases as they grow older rings true to most of us, although some older adults lead healthy and active lives without medical intervention.

“Every day, 10,000 Americans turn 65, and every day, more and more of them are just as fit as me” – so says Linda Marsa, contributing editor at Discover magazine. Richard Johnson, an economist, says “Today’s seniors are healthier, better educated, and more productive than ever.” Despite these positive trends, many would argue that the goal of geroscience – to explain and intervene in age-related diseases including arthritis – remains highly relevant to today’s societies.

Since life extension studies remain inconclusive, scientists are working to improve ‘healthspan’ – the length of time a person is healthy, especially in the later years. Brown University Professor Dr. Stephen L. Helfand is one of several researchers whose work is advancing the rapidly maturing field of ageing science. He is also senior author of the study mentioned above.

This study showed that many transposable elements (TEs) become activated with age in the fruit fly Drosophila* and that this activation is prevented by dietary restriction – an intervention known to extend lifespan. TEs are sequences of DNA (our genetic material) that move (or jump) from one location in the genome to another. Drosophila is a small fruit fly used extensively in genetic research. Why do scientists use fruit flies? Because fruit flies share 75 percent of the genes that cause disease with humans including having a smaller, fully-sequenced genome for easier genetic manipulations. Ultimately, the study provides evidence that preventing TE activation by dietary restriction may be a useful tool in ameliorating aging-associated diseases. The hope is that such results could be applied to humans as research progresses.

“Our demonstration that dietary [restriction], genetic and pharmacological interventions that reduce the age-related increases in [transposon] activity can also extend lifespan suggests new and novel pathways for the development of interventions designed to extend healthy lifespan.” according to this study. Despite the possibility of a true causal relationship, scientists can (happily!) avoid misleading phrases such as the Fountain of Youth, since geroscience hopes to improve health and longevity – not provide some mythical youth potion. Older people are a rapidly growing demographic – by 2100, the number of people aged 60 and over will reach 3.2 billion. It is, therefore, vital that researchers use terms that do not marginalize an increasingly growing demographic –  or maintain the current narrative of our youth-obsessed culture.

We have seen major breakthroughs in public health and medical research, including a generational leap in longevity, the use of antibiotics, the completion of the Human Genome Project, and more. Society has also reaped the benefits of new medical technologies and advances in nutrition such as sustainable diets, virtual reality, and food scanners. As the field of geroscience continues to evolve, both public and private sectors may increase investments for ageing research, especially if it can reveal treatments for conditions that afflict older people. More data is also needed to understand and support research findings including the current study by Dr. Helfand. This paper comes as scientists from three universities including, Brown University, New York University and the University of Rochester forge a new partnership in DNA-related research. The collaboration is supported by a five-year, $9.67-million grant from the National Institutes of Health. Hence, study outcomes could have a lasting effect on health and society. David Sinclair, a researcher of ageing at Harvard Medical School, has put this attitude into words: “The goal of this research is not to keep people in the nursing home for longer. It’s to keep them out of nursing homes for longer.”