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

1. Drink Wise, Age Well
Monday 02nd November 2015
#DrinkWiseAgeWell

2. Welcome
Simon Antrobus
CEO
Addaction
#DrinkWiseAgeWell

3. Why ‘Drink Wise,
Age Well’ ?

4. Partnership Approach

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. Helping people make healthier choices about
alcohol as they age
 Prevention and Campaigning
 Training and Skills Development
 Building Resilience
 Direct Engagement and Support

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. Dr Sarah Wadd
Director
Substance misuse and Ageing Research Team at the
Tilda Goldberg Centre, University of Bedfordshire
#DrinkWiseAgeWell

9. Evidence,
Research
and
Evaluation
England, 2015

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Dr Kieran Moriarty
Consultant Physician and Gastroenterologist
Bolton NHS FT
#DrinkWiseAgeWell

24. ALCOHOL – RELATED PROBLEMS IN
OLDER PEOPLE: CLINICAL FEATURES,
PRESENTATIONS AND VULNERABILITY
DR KIERAN MORIARTY
CONSULTANT GASTROENTEROLOGIST
ROYAL BOLTON HOSPITAL
ENGLAND

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. 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. Older Drinkers - Reasons
• Habitual
• Boredom
• Anxiety
• Depression
• Insomnia
• Grief
• Loneliness
• Ill health
• Pain

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. Diagnosis Issues

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. 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. Physiological Changes with Age
Decreased Lean
Body Mass
Decreased Total
Body Water
Decreased Gastric
EtOH Dehydrogenase
Increased Serum EtOH for a
given dose

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. Alcohol Consumption and Annual Risk of Death
Rehm et al, 2011

35. ALCOHOL ADMISSIONS-PRIMARY REASONS
( > 60 YEARS OLD)

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. 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. Alcohol and the Nervous System
• Behavioural changes of intoxication
• Acute alcohol withdrawal syndromes
• Wernicke’s encephalopathy/Korsakoff’s
syndrome
• Peripheral neuropathy
• Dementia

39. ALCOHOL – DRUG INTERACTION
• Prescribed
- hypnotics, anxiolytics, opioids, antibiotics,
anticoagulants, anti-depressants, epileptics,
hypertensives
• Over the counter – painkillers
• Illicit

40. ALCOHOL AND CO-MORBIDITY
• Ageing – “silent epidemic”
• Smoking – Cancer, Pneumonia, TB
• Hypertension
• Malnutrition
• Obesity
• Dementia
• Psychiatric
• “Dual diagnosis”

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. Don Lavoie
Alcohol Programme Manager, Alcohol Team
Public Health England
#DrinkWiseAgeWell

43. Drink Wise
Age Well
Don Lavoie – Public Health England

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. Hazardous and harmful drinking (APMS)
45 PHE Drink Wise Age Well

46. Alcohol dependence (APMS)
46 PHE Drink Wise Age Well

47. AUDIT Scores (APMS)
47 PHE Drink Wise Age Well

48. Binge drinking
48 PHE Drink Wise Age Well

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. 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 PHE Drink Wise Age Well

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. Burden of diseased 2013
53 PHE Drink Wise Age Well

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. 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. Alcohol - adds to health risks
56 PHE Drink Wise Age Well

57. 57 PHE Drink Wise Age Well

58. QOF registers and risky drinking
58 PHE Drink Wise Age Well

59. Alcohol-related hospital admissions in Torbay
59 PHE Drink Wise Age Well

60. Alcohol-related hospital admissions in Torbay
60 PHE Drink Wise Age Well

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. Professor José Iparraguirre
Chief Economist
Age UK
#DrinkWiseAgeWell

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. BMJ Open 2015 5 e007684 doi:10.1136/bmjopen-2015-007684

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. 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. 2. Data
Three alternative conversion tables:
• NHS ‘alcohol unit calculator’
• 2007 General Lifestyle Survey
• drinkaware website

68. 2. Data

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. 3. Results

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. 3. Results
Conditional
probability plot of
being at higher risk
drinking category by
age and gender

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. 3. Results (transitions between risk categories)
(Excerpt)

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. 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. 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. 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. 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. 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. Drink Wise, Age Well
Monday 02nd November 2015
#DrinkWiseAgeWell