There is already a significant amount of undetected hazardous drinking among elderly people. This could increase in the immediate future, not simply because life expectancy is rising but also because the “baby boomers” (people born in the years following World War 2) may carry relatively high levels of alcohol consumption into their later years. The time has come to consider age-specific recommendations for safe drinking levels. Since older people are less able to cope with alcohol (because of their lower proportion of body water, for example, together with a decline in the capacity of the liver to metabolise alcohol), it would be prudent to consider whether sensible drinking advice for older people should be set a level lower than that for the population as a whole.
These were the conclusions of the Portman Group seminar held in London October 2005. The event was chaired by Dr Bernard Dixon and the speakers were Professor Mary Gilhooly, Head of Gerontology Research at Glasgow Caledonian University, and Dr Ian Johnson, Consultant Old Age Psychiatrist at Foxbrake House, Dorchester, Dorset.
Professor Gilhooly highlighted the difficulty in comparing the level of drinking at different periods during life. Many doctors have the impression, and surveys seem to confirm, that alcohol consumption declines with age. However, most of these studies have simply recorded levels of consumption at different ages. They have not followed a group of people over time to see whether and how their intake changes. It is possible, therefore, that a “cohort effect” is responsible for the survey findings. Compared with today’s young people, today’s old people may have drunk less when they were young. In the same way, middle-aged “baby boomers” might carry higher consumption into their old age.
Gilhooly believes there is some evidence for this possibility. The worrying implication is that some of these individuals will not only be drinking harmfully in retirement but they will also have received a relatively large aggregate dose of alcohol over their entire lifetime. Improvements in personal financial standing, especially better occupational pensions, will facilitate the trend.
Dr Johnson presented statistics suggesting that 18% of men and 7% of women over 65 had alcohol problems. But he also reviewed a variety of types of evidence indicating a “hidden iceberg” of hazardous drinking. There were, for example, many less-than-obvious factors that regularly brought the problem to medical attention. These included occasions when individuals neglect their wellbeing and/or refuse social services such as meals-on-wheels. Alongside recognized triggers for alcohol abuse such as bereavement, retirement and loneliness, mental health has been neglected. Yet 13% of elderly depressives also have an alcohol problem.
Among failures by the medical profession, Johnson cited misdiagnosis (for example, some doctors’ unawareness that insomnia might be a consequence of alcohol misuse) to “a tendency to avoid embarrassing questions”. Surprisingly, the National Health Service provides treatment programmes for alcohol abuse up to, but not beyond, the age of 65.
Johnson also outlined the benefits that alcohol can bring to the elderly. He cited survey evidence indicating that moderate drinkers have not only a more active and sociable lifestyle than abstainers, but also more acute mental faculties. Whereas heavy drinking in old age is associated with a high rate of dementia, light drinking is associated with a lower rate. Safe drinking recommendations should take account of both the positive and negative effects of alcohol consumption.