Older people are more susceptible to the effects of alcohol due to their body’s decreasing ability to break it down. Alcohol circulates in an older person’s body for a longer time and the effects of drinking last longer. This in turn can leave older people vulnerable to a host of risks including falls, accidents, poor nutrition, health problems and financial difficulties.

Research from the Health Research Board Drug and Alcohol Survey shows that older drinkers reported drinking more frequently than those in younger age groups; 13.6% of drinkers aged 65 years and older consumed alcohol at least four times per week, compared with just 1.5% of drinkers aged 15–24 years (Table 10).

The Irish Longitudinal Study on Ageing (TILDA) found that while just 1.8% of older Irish adults reported a diagnosed history of alcohol or substance abuse, a self-reported audit taken during the survey showed overall prevalence of ‘problem drinking‘  higher at 4.8%, rising to 8.5% in men over 50. Tilda researchers highlighted that despite the decline in average weekly consumption and heavy episodic drinking, the observed quantities consumed and the increase in frequency of consumption suggest that older Irish adults are vulnerable to alcohol-related harms.

Alcohol and health concerns
Alcohol problems typically present in older people as falls, dementia, cardiac problems, hypertension, insomnia, confusion, depression or self-neglect. Studies have estimated that up to 14% of emergency department admissions are due to alcohol use disorder in elderly people, 18% for medical inpatients and 23-44% for psychiatric inpatients.

Alcohol problems left untreated in older people can worsen and can affect the brain with issues relating to this usually manifesting later in life.

Alcohol-related dementia, such as Korsakoff’s Syndrome and  Wernicke Encephalopathy are serious illnesses caused by a combination of high alcohol use and poor nutrition. People who acquire them require identification and appropriate treatment pathways for person-centred and rehabilitation-focused care.

Age-appropriate services

Research has found that late-onset alcohol problems can be related in part to issues like loneliness, depression and the stresses of ageing.

(Organisations like Alone or the Samaritans can help in such situations).

Ageing populations worldwide means that the absolute number of older people with alcohol use disorders is on the increase, and health services need to improve their provision of age appropriate screening and treatment methods and services.

This knowledge, however, has not led to the creation of age appropriate alcohol services as required. In 2011, a report, written by the UK’s Older People’s Substance Misuse Working Group of the Royal College of Psychiatrists, warned that not enough was being done to tackle problem substance use in our ageing population – making them society’s “invisible addicts.”

Ireland’s national drug and alcohol policy, Reducing Harm, Supporting Recovery while acknowledging issues around older people and heroin use is silent on the specific matter of alcohol and older people’s needs, but an action point does set out a need to examine the development of specialist services. Older people would certainly fall into this category.

Interventions that work

A recent evaluation of interventions with older people with alcohol issues in the UK found that stigma reducing interventions that focus on one-to-one support, building resilience and social connections and peer support work really well for older adults with alcohol problems.
The report points to the value of specific campaigns for older people, “not just rehab type services as many people who are drinking in a harmful way are not dependent as such but have multiple ill effects from alcohol.”

The study also found that two thirds of those receiving advice had never been asked about their drinking before with 62% receiving the intervention saying it was the first time they had received an intervention.

This points to missed opportunities and a clear need for provision of alcohol screening and brief advice at ‘teachable moments’ or times of crisis (e.g. presentation of drinkers at hospital emergency Departments) that may reach people and facilitate access to specialist alcohol treatment.