Alcohol and Older People: what’s the harm?

Exploring the association between drinking in later life and the harm associated with alcohol consumption is riddled with pitfalls. This often means that the evidence presented has a number of limitations when it comes to how confident we can be about drawing meaningful conclusions.

In both household surveys and more sophisticated research protocols, there remains considerable variation in how alcohol consumption is both reported and recorded. Reporting how much we drink can only be truly accurate if we keep a day to day diary of our alcohol intake. Even in my clinical work, I have only ever come across one person who did this, but the stark reality is that the majority older people do not. Even if there is a drink diary, it is still unlikely that both the volume and percentage alcohol by volume is recorded. If this is the case, we are only scratching the surface at a population level when we ask about older people’s drinking habits, limiting our questions to a ‘typical drinking day’ or the ‘average amount consumed in a drinking session’. Any errors in rough approximations of this sort can only be magnified when considering weekly or monthly drinking.

Another problem with older people understanding and reporting how much they drink is the age old concept of a ‘Unit of Alcohol’. General Household surveys have shown that older people have a poorer understanding of units of alcohol compared with younger people. This is made even more complicated if we look at a global level, where, for example, in the USA a standard ‘drink’ is equivalent to 12 grammes of pure alcohol (ethanol). In the UK, a Unit of alcohol is equivalent to 8 grammes of pure alcohol. Who then can blame people for being totally lost when it comes to measuring their alcohol intake, with alcoholic drinks varying in alcohol by volume from 4% to 40%? When we take into account memory problems in older people’s reporting of how much they drink, this muddies the waters even further.

If the above measurements were not difficult enough to measure, we then have the biggest elephant in the room, which is stigma. Although the advent of the rising ‘Baby Boomer’ population has changed attitudes to drinking and being more open about drinking, there is still is a sizeable number of older people who are every wary of being labelled ‘alcoholic’. The ensuing under-reporting of alcohol intake can heavily skew data about alcohol intake to the extent that such people fall into what might commonly be called ‘moderate drinking’.

To conclude with two final thoughts. Time and time again, even data that records alcohol consumption across decades of people’s lives is compounded by the phenomenon of what are called ‘sick quitters’, which includes those who choose to drink less or even abstain for both health and lifestyle reasons. This group of older people is all too commonly lumped together with ‘abstainers’ , resulting in a heterogeneous population that lead to conclusions that have little application to the wider population. Older people are also more likely to have both physical and mental health problems and take medication that makes them more sensitive to the effects of alcohol, so ‘safe drinking limits’ may not apply.

Do we really thing we can be sure about the association between alcohol and harm in older people? In particular, can we be sure that current sensible limits for younger people also apply to their older counterparts and that we are really getting an accurate picture of the nature and extent of harm in an older population who remain comparatively hidden and forgotten? The jury is still out and is probably unlikely to return for several years, but the truth is still out there somewhere.

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