Alcohol and older people: a public health perspective

Compared with younger people, there is a paucity of data describing alcohol use, alcohol-related harm and effective policy and preventive approaches amongst older people. Nevertheless, compared with their younger counterparts, older people do not suffer from disproportionally higher levels of harm: in general, they drink less, drink less hazardously, and suffer less harm. In absolute terms, they experience a much lower number of deaths and hospital admissions for conditions wholly attributable to alcohol than their younger adult counterparts. When considering conditions partially attributable to alcohol, the estimated number of deaths and particularly the number of hospital admission become much higher, although these numbers are likely to be inflated due to the application of attributable fractions estimated for younger adults applied to older adults. Many surveys have suggested that light drinking older people (up to 20g alcohol per day) experience a better quality of life than non-drinking or heavy drinking counterparts. However, it is unknown the extent to which this is due to other factors, including drinking patterns, and it may simply mean that lighter drinkers are healthier, wealthier and better socially integrated people than non-drinkers or heavier drinkers.



It is questionable that older people are at particular risk of alcohol-related conditions that might be more common for their age. The evidence is simply inconclusive to suggest that there are at greater risk of falls and fractures. If anything, small doses of alcohol seem to reduce the risk of dementia and Alzheimer’s disease. Light older drinkers also have less risk of dying over short follow-up periods than non-drinkers or heavier drinkers, although, again, it is difficult to be certain how much of this effect is due to other confounding variables. The one area where older people might be at special risk is interactions with medications, older people being more likely to take medications than younger adults. Although, the extent to which this is a significant health problem is not known.


There are a wide range of evidence based alcohol policies that reduce the harm done by alcohol, but none of these have been evaluated for their specific impact on older people. However, there is no reason to assume that older people would not react to alcohol policy interventions different from younger adults. Certainly, the policy option that is likely to have the greatest impact is increasing the price of alcohol, which, amongst other things, leads to immediate reductions in alcohol dependence, liver cirrhosis and alcohol-related mortality. For those older people, whose consumption of alcohol is hazardous or harmful, the, albeit limited, evidence suggests that screening and brief intervention programmes are just as effective as for the younger adult populations.


The number of older Europeans will increase enormously over the coming years - in the next twenty years alone, people aged 65 years and older will increase in number from the current 87 million to 123 million, and people over 80 years of age will increase in number from the current 23 million to 36 million. These people are the present middle age, who have high levels of both frequency and volume of drinking. They are also the group of people with the highest levels of wholly attributable alcohol related hospitalization and death. To prevent burgeoning alcohol-related problems amongst older people over the coming twenty years, it is important to target policy on the present middle age, which will also have an immediate impact in reducing alcohol-related hospitalizations and deaths. Further, many alcohol-related conditions, and in particular cancers, have a long latency period in terms of both cause and reduction in risk. Thus, if one wishes to prevent an increase in alcohol-related cancers and other conditions in older people, action should also be taken on the middle-aged. From a policy perspective, actions that reduce the consumption of the middle aged, will not only prevent problems for a future cohort of older people but, at the same time, reduce patterns of hazardous and harmful alcohol consumption amongst the existing cohort of older people.
 
 
 
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