Our Forgotten Generation

Generations come and go but the current generation of ‘Baby Boomers’ are no ordinary generation. While we are starting to see falling rates of alcohol consumption in younger people, the proportion of older people drinking over recommended limits has shown little change. The General Lifestyle Survey published by the Office of Nation Statistics in March 2013 showed that between 2005 and 2013, the percentage of men drinking 8 or more units of alcohol (the equivalent of 4 or more pints of normal strength beer) on any one day in the past week had changed by only 5% in the 65 and over age group. This compares to reductions of 30%, 19% and 12% in the 16-24, 22-44 and 45-64 age groups respectively http://www.ons.gov.uk/ons/dcp171776_302636.pdf

The above observation mirrors my own clinical practice. Although I work in area which has a higher proportion of older people with alcohol misuse than the general UK population, I am beginning to witness a worrying trend. No sooner has my NHS Trust put in place a system that is better able to identify, treat and refer on older people whose alcohol misuse accompanies other mental health problems, there now exists a new ‘forgotten generation’ of older people with alcohol problems. One the one hand there is the group who are slowly drinking themselves into ill health over a longer period of time than they would have, given increasing longevity. There is also another less visible group whose alcohol misuse does not accompany other mental health problems, who alienate themselves from others through neglecting themselves and their living conditions. They do not consider themselves in need of help and find themselves homeless or in hospital from alcohol related complications such as falls. Services struggle to know what to do and these older people remain stuck in a downward spiral.

It is not enough to campaign for an improvement in resource allocation. Any awareness raising needs to be backed up by robust evidence. Much of the current evidence comes from the Office of National Statistics (ONS), but austerity bites and there was a very real risk that data on alcohol consumption would be lost. In 2013, there was a 2 month consultation period by the ONS in ‘seeking your views to inform necessary reductions to its statistical outputs’ http://www.ons.gov.uk/ons/about-ons/get-involved/consultations/consultations/statistical-products-2013/index.html. This included the General Lifestyle Survey, which contains invaluable data to inform policy and resource allocation, as can be seen from the above changes in drinking trends over the past 7 years. Following the end of the consultation, Marmot and Goldblatt published an Editorial in the British Medical Journal, emphasising the importance of monitoring health inequalities http://alturl.com/u5txu, to which I responded http://www.bmj.com/content/347/bmj.f7034.

Thankfully, ‘high impact outputs, supported by a wide range of stakeholders’ will still include General Lifestyle Survey data on drinking and the Annual statistical bulletin on alcohol-related deaths in the UK, although the former will report a smaller sample size.

I have little doubt that we will continue to see a trend in rising number of older people for whom alcohol is no ordinary commodity and for many, whose drinking will put them at both immediate and long term risk of health problems. Many of these older people will drink as a consequence of changing life circumstances, in particular retirement, social isolation and bereavement. Older people have now also been identified as an ‘at risk’ group worthy of special attention alturl.com/ec5od 

Older people with alcohol misuse have different needs when considering services designed to help them in changing their drinking behaviour and improve their quality of life. Treating any accompanying mental illness such as depression is just one approach, but reducing loneliness, reducing stigma in seeking help and improving awareness of the interaction between alcohol and health (e.g. health problems such as sugar diabetes and high blood pressure or interactions with prescribed medication) are just some others.

There remain several barriers to older people with alcohol misuse receiving the help that they need, from seeking help through to detection and treatment. Given the trends in drinking in our older people, we do not want to close the stable door after the horse has bolted. When considering the demand for improving skills in the detection and treatment of alcohol misuse in older people by service providers, we are now pushing against an open door http://www.hsj.co.uk/comment/older-people-are-our-forgotten-addicts/5065595.article

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