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02Nov15 - Drink Wise Age Well programme launch

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On the 2nd November 2015, ILC-UK held a panel discussion to launch the Drink Wise, Age Well programme.

The event brought together important stakeholders to discuss the growing problem of alcohol misuse in the over 50s population of the UK. Supported by the Big Lottery Fund, Drink Wise, Age Well brings together 6 strategic partners; Addaction, the Royal Voluntary Service, International Longevity Centre UK, Drugs and Alcohol Charities Wales, Addiction Northern Ireland and the University of Bedfordshire.

With at least 20% of over 50s in the UK exceeding recommended alcohol units, and alcohol related harms significantly increasing in this age group, Drink Wise, Age Well will aim to create a healthier relationship with alcohol for the overs 50s population through a preventative approach.

As part of our programme evaluation we have recently carried out a survey of drinking behaviour in people aged 50 and over which more than 17,000 people completed.

Joining our panel to discuss this important and growing issue were:

- Simon Antrobus, CEO, Addaction (Chair)
- Don Lavoie, Alcohol Programme Manager, Alcohol Team, Public Health England
- Dr Sarah Wadd, Director, Substance misuse and Ageing Research Team at the Tilda Goldberg Centre, University of Bedfordshire
- Professor José Iparraguirre, Chief Economist, Age UK
- Dr Kieran Moriarty, Consultant Physician and Gastroenterologist, Bolton NHS FT

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02Nov15 - Drink Wise Age Well programme launch

  1. 1. Drink Wise, Age Well Monday 02nd November 2015 #DrinkWiseAgeWell
  2. 2. Welcome Simon Antrobus CEO Addaction #DrinkWiseAgeWell
  3. 3. Why ‘Drink Wise, Age Well’ ?
  4. 4. Partnership Approach
  5. 5. Is alcohol and ageing an issue? The most significant increases in alcohol-related harm in recent years have occurred in older people 1 in 3 alcohol problems in older people occur for the first time in later life, therefore it is never too late for prevention Alcohol problems are less likely to be detected in older people Older people are more likely to be treated successfully for an alcohol problem than younger people
  6. 6. Helping people make healthier choices about alcohol as they age  Prevention and Campaigning  Training and Skills Development  Building Resilience  Direct Engagement and Support
  7. 7. Numbers Recap • £25 million grant • 7 years ( 5 operational) • 5 demonstration areas • 6 Strategic Partners • 19 Portfolio Projects • 89 Drink Wise Age Well staff
  8. 8. Dr Sarah Wadd Director Substance misuse and Ageing Research Team at the Tilda Goldberg Centre, University of Bedfordshire #DrinkWiseAgeWell
  9. 9. Evidence, Research and Evaluation England, 2015
  10. 10. Extent of the Problem • 25% of men and 16% of women aged 50+ exceed recommended weekly limits • 33% of men and 23% of women aged 50+ exceed recommended daily limits Health Survey for England, 2013
  11. 11. 0 5 10 15 20 25 30 35 50-59 60-69 70-79 80+ Percent Men Women Health Survey for England, 2013 Exceeding Recommended Weekly Limits
  12. 12. What proportion of people with alcohol problems are 50+ • Amongst men, half of harmful drinkers (50%) and just under half of hazardous drinkers (48%) are 50+ • Amongst women, 43% of harmful drinkers and 43% of hazardous drinkers are 50+ Health Survey for England, 2013
  13. 13. Alcohol-Related Hospital Admissions, England Source: Wadd, 2012 0 2,000 4,000 6,000 8,000 10,000 12,000 2002 2003 2004 2005 2006 2007 2008 2009 2010 Rateper100,000population 25-34 35-44 45-54 55-64 65-74 75+
  14. 14. Drink Wise, Age Well Questionnaire Study • Questionnaire sent to over 50’s before and after programme • Demonstration and control areas • More than 17,000 people aged 50 and over completed questionnaire • Only survey specifically designed to examine drinking behaviour in later life worldwide
  15. 15. Betty: Aged 72, retired, widowed, lives alone • Drinks 2-3 times a week, more than 10 units on a typical day • On weekly basis not able to stop drinking when started and had a feeling of guilt or remorse after drinking • Drinks because she likes the way it makes her feel, to take her mind off problems, when she feels down or depressed, when she feels lonely or bored • Alcohol impacts negatively on her energy levels and mood • She is not coping with stresses in life, is not happy with life, doesn’t get the emotional help she needs from her family, doesn’t have a special person that she can share her joys and sorrows with, doesn’t engage in activities that she find enjoyable and fulfilling • Not confident in her ability to calculate or keep track of alcohol units • Wouldn’t tell someone if she had an alcohol problem • Thinks that people with alcohol problems have themselves to blame
  16. 16. David: Aged 52, working • Drinks 4 or more times a week, 100 units in last seven days • Drinks because likes the taste of it, likes the way it makes him feel, to be sociable and to relax • Not worried about his drinking • Does not know what recommended daily limits are • Not been asked about alcohol use in last 12 months
  17. 17. Other research and evaluation • Interviews/focus groups with people who have received interventions including repeat interviews/focus groups to get sense of impact over time • Interviews with stakeholders and DWAW staff to find out to find out what is (and isn’t working well) and what could be improved
  18. 18. Other research and evaluation • Routine data gathering throughout for example number of people who have positive cognitive impairment screening test • Before/after survey to measure professional capacity and confidence (knowledge, skills and networks) in recognising and responding to alcohol problems in over 50’s
  19. 19. Special Focus Sheffield - Ethnicity • Minority ethnic groups have similar levels of alcohol dependence despite drinking less • Minority ethnic groups are under- represented proportionately in seeking treatment and advice for alcohol problems • People belonging to minority ethnic groups with strong religious ties that forbid drinking may hide their drinking for fear of repercussions and bringing shame on their families
  20. 20. Evaluation Ethnicity • Routine data monitoring to ensure minority ethnic groups are accessing services • Explore extent to which interventions are accessible and culturally sensitive to needs of minority ethnic groups in interviews and focus groups • Analysis of survey data to see if programme has had the same impact on minority ethnic groups
  21. 21. Special Focus Devon - Lifestage • People at different lifestages have different needs • Those entering old age may need help preparing for life-transitions such as retirement and ‘empty- nest’ syndrome • ‘Older olds’ may be housebound or require information in different formats e.g. enlarged print
  22. 22. Evaluation Lifestage • Routine data monitoring to ensure people from all age groups are accessing services • Extent to which interventions meet the needs of people from different lifestages explored in interviews and focus groups • Analysis of survey data to see if programme has had the same impact on people at different life stages
  23. 23. Dr Kieran Moriarty Consultant Physician and Gastroenterologist Bolton NHS FT #DrinkWiseAgeWell
  24. 24. ALCOHOL – RELATED PROBLEMS IN OLDER PEOPLE: CLINICAL FEATURES, PRESENTATIONS AND VULNERABILITY DR KIERAN MORIARTY CONSULTANT GASTROENTEROLOGIST ROYAL BOLTON HOSPITAL ENGLAND
  25. 25. Prevalence Alcohol Problems in Older People • A & E Departments….. 14% • Medical inpatients……. 6-11% • Psychiatric inpatients… 20% • Nursing home patients.. Up to 49%
  26. 26. Early v. Late Onset Alcoholism Early onset: • Describes those who have a lifelong pattern of drinking, have probably been alcoholic all their life, and are now elderly. • More likely to have chronic alcohol-related medical problems such as cirrhosis, organic brain syndrome, and co-morbid psychiatric disorders. Late onset: • Describes those who have become alcoholic in their drinking pattern for the first time late in life. • Often triggered by a stressful life event. • Generally represented by milder cases with fewer accompanying medical problems. • More amenable to treatment, more likely to have spontaneous recovery, but also more likely to be overlooked by health care professionals (Liberto & Oslin, 1995).
  27. 27. Older Drinkers - Reasons • Habitual • Boredom • Anxiety • Depression • Insomnia • Grief • Loneliness • Ill health • Pain
  28. 28. Signs & Symptoms • Anxiety • Blackouts, dizziness • Depression • Disorientation • Mood swings • Falls, bruises, burns • Family problems • Financial problems • Headaches • Incontinence • Increased tolerance • Legal difficulties • Memory loss • New problems in decision making • Poor hygiene • Seizures, idiopathic • Sleep problems • Social isolation • Unusual response to medications
  29. 29. Diagnosis Issues
  30. 30. Practitioner Barriers to Identification • Ageist assumptions • Failure to recognize symptoms • Lack of knowledge about screening • Physician discomfort with substance abuse topic - 46.6% of primary care physicians found it difficult to discuss prescription drug abuse with their patients (CASA, 2000)
  31. 31. Individual Barriers to Identification • Attempts at self-diagnosis • Description of symptoms attributed to ageing process or disease • Many do not self-refer or seek treatment - Although most older adults (87 percent) see physicians regularly, an estimated 40 percent of those who are at risk do not self-identify or seek services for substance abuse (Raschko, 1990)
  32. 32. Physiological Changes with Age Decreased Lean Body Mass Decreased Total Body Water Decreased Gastric EtOH Dehydrogenase Increased Serum EtOH for a given dose
  33. 33. Relative Risks of Mortality from Coronary Heart Disease by Level of Alcohol Intake Source: Britton derived from meta-analysis by Corrao et al. (2000)
  34. 34. Alcohol Consumption and Annual Risk of Death Rehm et al, 2011
  35. 35. ALCOHOL ADMISSIONS-PRIMARY REASONS ( > 60 YEARS OLD)
  36. 36. Alcohol and Stroke • ISCHAEMIC STROKE - Mild-mod consumption reduces risk - Heavy consumption increases risk (but cigarettes and blood pressure confound) • HAEMORRHAGIC STROKE - More frequent for regular (>40g/d) and binge drinkers
  37. 37. Alcohol and Musculoskeletal System • Most important effect is through violence and falls • Chronic alcohol misuse leads to: - Osteoporosis - Reduced calcium and magnesium - Depressed 25-hydroxyvitamin D - Myopathy
  38. 38. Alcohol and the Nervous System • Behavioural changes of intoxication • Acute alcohol withdrawal syndromes • Wernicke’s encephalopathy/Korsakoff’s syndrome • Peripheral neuropathy • Dementia
  39. 39. ALCOHOL – DRUG INTERACTION • Prescribed - hypnotics, anxiolytics, opioids, antibiotics, anticoagulants, anti-depressants, epileptics, hypertensives • Over the counter – painkillers • Illicit
  40. 40. ALCOHOL AND CO-MORBIDITY • Ageing – “silent epidemic” • Smoking – Cancer, Pneumonia, TB • Hypertension • Malnutrition • Obesity • Dementia • Psychiatric • “Dual diagnosis”
  41. 41. Older Persons Concerns about Treatment: • Treatment takes too long • It’s embarrassing to tell people • Treatment is just for kids • Treatment is just for addicts • Treatment is too expensive • Being away from home
  42. 42. Don Lavoie Alcohol Programme Manager, Alcohol Team Public Health England #DrinkWiseAgeWell
  43. 43. Drink Wise Age Well Don Lavoie – Public Health England
  44. 44. Drinking “At Risk” groups 44 PHE Drink Wise Age Well Source: Health Survey for England 2013 (ONS) & Adult Psychiatric Morbidity Survey 2007 7.6m 17% 7.4m 17% 1.6m 4% 27.7m 64% 6.7m 15% 1.7m 4%
  45. 45. Hazardous and harmful drinking (APMS) 45 PHE Drink Wise Age Well
  46. 46. Alcohol dependence (APMS) 46 PHE Drink Wise Age Well
  47. 47. AUDIT Scores (APMS) 47 PHE Drink Wise Age Well
  48. 48. Binge drinking 48 PHE Drink Wise Age Well
  49. 49. Men – drinking 5+ days (GLS ONS) Drinking in the last week 2005 1 2006 2 2007 2 2008 2 2009 2 2010 2 2011 2 Percentages Men Drank last week 16-24 64 60 64 63 55 49 52 25-44 74 73 74 72 70 69 67 45-64 77 76 76 74 72 73 72 65 and over 66 67 67 66 66 65 63 Total 72 71 72 70 68 67 66 Drank on 5 or more days last week 16-24 10 8 9 6 7 5 5 25-44 18 17 18 14 13 12 11 45-64 28 26 27 24 23 20 22 65 and over 26 27 29 27 27 26 24 Total 22 21 22 19 18 17 16 49 PHE Drink Wise Age Well
  50. 50. Women – drinking 5+ days (GLS ONS) Drinking in the last week 2005 1 2006 2 2007 2 2008 2 2009 2 2010 2 2011 2 Percentages Women Drank last week 16-24 56 53 54 52 51 46 50 25-44 62 60 61 59 59 56 56 45-64 61 61 61 60 59 60 60 65 and over 43 44 45 43 43 43 42 Total 57 56 57 55 54 53 54 Drank on 5 or more days last week 16-24 5 3 4 2 2 2 3 25-44 11 9 11 9 7 7 6 45-64 17 15 15 15 14 13 12 65 and over 14 15 15 15 14 14 13 Total 13 11 12 11 10 10 9 50 PHE Drink Wise Age Well
  51. 51. 51 PHE Drink Wise Age Well
  52. 52. 52 PHE Drink Wise Age Well Burden of disease attributable to 20 leading risk factors for both sexes in 2010, expressed as a percentage of UK disability-adjusted life-years * ]
  53. 53. Burden of diseased 2013 53 PHE Drink Wise Age Well
  54. 54. Alcohol-related deaths and morbidity 21,485 deaths were attributable to alcohol in England in 2011-12 alcohol-related hospital admissions in 2012-13, 350,000 where an alcohol- related condition or cause was the main reason for admission. 1 million 5 PHE Drink Wise Age Well
  55. 55. 3 “Ages” of alcohol harm 55 PHE Drink Wise Age Well 0 10 20 30 40 50 60 70 AGE Younger people Middle age Older people FREQUENCY OF HARM ACUTE HARM – accidents, poisoning ACUTE DISEASE – liver, pancreas ATTRIBUTABLE HARM – cancers, heart disease
  56. 56. Alcohol - adds to health risks 56 PHE Drink Wise Age Well
  57. 57. 57 PHE Drink Wise Age Well
  58. 58. QOF registers and risky drinking 58 PHE Drink Wise Age Well
  59. 59. Alcohol-related hospital admissions in Torbay 59 PHE Drink Wise Age Well
  60. 60. Alcohol-related hospital admissions in Torbay 60 PHE Drink Wise Age Well
  61. 61. Conclusions  CMOs currently looking at “sensible drinking message” and lower-risk guidelines. This may set different limits for older people and other groups  Older people are responsible for most partially attributable alcohol-related hospital admissions, but less wholly attributable alcohol-related hospital admissions  There are a number of opportunities to intervene: NHS Health Check Selective QOF Registers Hypertension Depression Making Every Contact Count 61 PHE Drink Wise Age Well
  62. 62. Professor José Iparraguirre Chief Economist Age UK #DrinkWiseAgeWell
  63. 63. Prof. José Iparraguirre Chief Economist, Age UK Monday, 2 November 2015 Socioeconomic determinants of risk of harmful alcohol drinking among people aged 50 or over in England
  64. 64. BMJ Open 2015 5 e007684 doi:10.1136/bmjopen-2015-007684
  65. 65. 1. Literature Review a. Only reviewed papers on determinants b. Identified covariates: Age, Gender, Depression, Loneliness, Income, Education, Marital Status, Smoking, Dietary Habits, Social Ties, Physical Activity, Self-reported health, Co-habitation c. Abstainers as different group
  66. 66. 2. Data NICE guidelines: Lower-risk drinking: ≤ 21 units per week (adult men) or ≤ 14 units per week (adult women). Increasing-risk drinking: 22 ≤ 50 units per week (adult men) or 15 ≤ 35 units per week (adult women). Higher-risk drinking: > 50 alcohol units per week (adult men) or > 35 units per week (adult women).
  67. 67. 2. Data Three alternative conversion tables: • NHS ‘alcohol unit calculator’ • 2007 General Lifestyle Survey • drinkaware website
  68. 68. 2. Data
  69. 69. 2. Data English Longitudinal Survey of Ageing (ELSA) (Wave 5) – For transition study, Waves 4 and 5 Sample population aged 65 or over 5,071 cases with full records Variables included: Age, Income, Education, Smoking, Physical Activity, Depression, Loneliness, Self-Reported Health, Ethnicity, Gender, Marital Status
  70. 70. 3. Results
  71. 71. 3. Results Risk increases: The younger the person The higher their income The more educated The more physically active The better the self-reported health status Among White people (against non-whites) Among Males Among Widowers (against Widows, not against other Marital Status irrespective of gender)
  72. 72. 3. Results Conditional probability plot of being at higher risk drinking category by age and gender
  73. 73. The non-linear association with age and the associated finding that, for men, the probability of being in the higher risk category peaks in the mid-60s could give empirical support to the hypothesis that current cohorts of older people are carrying on the relatively higher consumption levels they exhibited earlier on in their lives into older age compared to previous cohorts. 3. Results
  74. 74. 3. Results (transitions between risk categories) (Excerpt)
  75. 75. For women not classified as higher risk drinkers in W4: - being lonely - being younger and - having a higher income are associated with a higher probability of becoming a higher risk alcohol drinker in W5. Observing a healthy diet is associated with a lower probability of becoming a higher risk alcohol drinker. 3. Results (transitions between risk categories)
  76. 76. For men not classified as at higher risk in W4: - not eating healthily is associated with a higher probability of becoming a higher risk alcohol drinker in W5 - having children living in the household increases the likelihood of ceasing to be at higher risk by W5 3. Results (transitions between risk categories) The older they are, the less likely they may become higher risk drinkers, and for those at a higher risk category, the more likely it is that they may cease to be so. The higher their income, the more likely they may become higher risk drinkers if they were not so, and the less likely that they cease to be higher risk drinkers if they were so.
  77. 77. People • in better health, • with higher income, • higher educational attainment and • socially more active are more likely to drink at harmful levels 4. (Main) Conclusion
  78. 78. 4. (Unpleasant) Corollaries? Consequently, 1. Is the problem of harmful alcohol drinking among people aged 50 or over in England a middle-class phenomenon? 2. Are those ageing ‘successfully’ developing harmful drinking consumption patterns?
  79. 79. Prof. José Iparraguirre Chief Economist, Age UK Monday, 2 November 2015 Socioeconomic determinants of risk of harmful alcohol drinking among people aged 50 or over in England
  80. 80. Panel Debate and Q&A • What are the age-specific problems associated with harmful drinkers in the over 50s population? • How can we best promote a healthier relationship with alcohol in the over 50s population? • Can you envisage any challenges to the project? • How can we raise the profile of this issue amongst policy makers? #DrinkWiseAgeWell
  81. 81. Drink Wise, Age Well Monday 02nd November 2015 #DrinkWiseAgeWell

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