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Alcohol in the Over 50’s. Dr F Robinson Surrey & Borders NHS Partnership Trust March 2013. Over the Hill, Already: Why 50 May Be the New 70. 65 is the new 25. Bowie's golden years: why sixties are the new forties . 50 Is The New 30, 60 Is The New 40. Quintastic: 50 is the new 30.
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Alcohol in the Over 50’s Dr F Robinson Surrey & Borders NHS Partnership Trust March 2013
Over the Hill, Already: Why 50 May Be the New 70 65 is the new 25 Bowie's golden years: why sixties are the new forties 50 Is The New 30, 60 Is The New 40 Quintastic: 50 is the new 30 If 60 Is the New 40, Is 80 the New Retire Fifty is the new 20 Why 50 is the new 65 80 is the new 65 Why 65 is the new 55 70 Is The New 50 Is 50 the New 30? Why 72 Is the New 30 Study on ageing finds 70 is the new 30
Alcohol Abuse • Alcohol abuse is a problem for people of all ages • More likely to go unrecognised • 1 in 6 older men, and 1 in 15 older women drinking at harmful levels • 1 in 3 older people with drinking problems develop them in later life • Increased risk of high blood pressure, type 2 diabetes and dementia • Clear need for government action around this problem
Mortality: Average Life Spans • Most common age at death in 2010 was 85 for men and 89 for women • 1960-2010 - increased by 10 yrs men, 8 yrs women • Population is living longer than ever before • Alcohol dependence - mean age at death was 60 for females and 58 for males, both of which are about 20 years lower than the mean age at death among the general population.
Health Expectancies 2008–2010 • Expect to spend >80 % of lives in very good or good general health from birth, falling to 57 % age 65. • Males greater proportion in favourable health compared with females. • Gap is narrowing - as the health of females has improved more rapidly than for males.
Alcohol Use Last 30 yrs • Small, steady increase in amount consumed • Alcohol 65 % more affordable now than in 1980 • 5.2 % of household spending vs7.5 %in 1980 • Ageneration with drinking habits established when alcohol generally has been more affordable and acceptable
Drinking Habits • 50-60 year olds represent the 'baby boomers’ • More liberal and permissive attitudes to many social activities. • More likely to retain old drinking habits as age
Binge Drinking • Drinking > 2 x daily units in one session. • Men > 8 units, women > 6 units • Individual variation in rate at which reach intoxication • Binge drinking major factor in accidents, violence and anti-social behaviour.
Calculate Units ABV % = units in 1 litre Volume drink (ml) x ABV% = UNITS 1000
2011-reported-consumption Young adults Adults over 45 Drink less per day More likely to drink on most days • More likely to drink heavily (binge) on a single occasion • Drink on fewer days in the week
YouGov Poll - 2010 • >55% thought alcohol only damages your health if you regularly get drunk or binge drink. • 83% believed regularly drinking > the recommended daily limits didn’t put their long-term health at risk. • 7.5 million people might be unaware of the damage their drinking could be causing.
OVER 50’s • Recreational • Habitual • Established dependence • Develop habitual/ dependence
Why? • A third of older people with drinking problems will develop first time in later life. • Make difficulties more bearable. • Less pressure to give up drinking, fewer family responsibilities, no work • Older people tend not to talk about their drinking • Mistake effects of alcohol for physical or mental health problem.
Feelings of loss • Disruption caused by retirement • Children leaving home • Divorce • Death of loved ones • Isolation • Loneliness • Illness • Pain
Helps sleep • Relaxes • Alleviates anxiety • Apperatif • Confidence
Aging Process • Lose muscle • Gain fat • Less efficient at breaking down alcohol • Ratio of water to fat changes - higher blood alcohol levels from smaller amounts of alcohol. • Capacity to tolerate toxic effects reduces. • React more slowly • Lose our sense of balance
‘Unbelievable’ • I think people will be infuriated by this. • It's described as a public health problem, it's actually a private health matter. • As people's horizons narrow, as they get older, eating and drinking are one of the few pleasures that remain with them for a very long time. • Going to the pub is the last social activity for many, many people. Editor of Saga magazine, Emma Soames
Isn't it time the thought-police left us oldies alone. • We've made it to old age in spite of all the claptrap appearing from time to time as scientific findings. • This is another example of health professionals reporting silly generalisations. • To coin a Wimbledon phrase "You cannot be serious"! 1.5 units is one small glass of wine - one sixth of a bottle a day.
I wish these people would stop scaring the over 65's • More fascistic, controlling, puritanical invective. Oldsters, ignore this and seize the day. • Body efficiency declines throughout life: our ability to ignore directives from journalists, psychiatrists, politicians - all big drinkers – increases.
Medications • Many interact with alcohol • Increase sedation, confusion • Opiates, antidepressants, benzodiazepines • May increase toxicity • May reduce effectiveness • May accidentally take too many
Liver Disease • Liver disease causes approximately 2% of all deaths. • Alcoholic liver disease0.8% of all deaths • The number of people who die from liver disease in England is rising • 90% of people who die from liver disease are under 70 years old • People dying from liver disease often have complex end of life care needs and over 70% die in hospital.
Am I Dementing? Normal ‘Old Age’ ?Dementia Difficulty performing simple tasks, forgetting how to do things Unable to recall or describe specific instances where memory loss caused problems Gets lost or disoriented even in familiar places; unable to follow directions Words frequently forgotten, misused, or garbled; Repeats in same conversation Trouble making choices, poor judgment, behave in socially inappropriate ways • Function independently, pursue normal activities, despite occasional memory lapses • Recall and describe incidents of forgetfulness • May pause to remember directions, but doesn’t get lost in familiar places • Occasional difficulty finding the right word, but no trouble holding a conversation • Judgment and decision-making ability the same as always
Reversible effects of memory loss • Side effects of medication. • Depression • Vitamin B12 deficiency. • Thyroid problems. • Alcohol abuse. • Dehydration
Brain • Significant loss of brain tissue in chronic alcoholics compared with controls, independently of Wernicke's encephalopathy but nutritional deficits may make the situation worse. • Cerebral atrophy • Repeated alcohol withdrawal may lead to greater cognitive impairment & have a bearing on the dementing process. • 700 000 people in the UK currently suffer from dementia • Alzheimer's disease, vascular and Lewy body dementia are considered to be the main causes. • Alcohol-related dementia is largely overlooked
Alcohol Related Dementia • Decline in cognitive or physical functioning relatively non-progressive in abstinent ex-drinkers, or even partially reversible • Improvement in working memory, visuo-spatial functioning, problem solving and attention • Some increase in brain volume over a period of up to a year • Impairments in areas of learning and short-term memory are more persistent. • `Heavy alcohol use’ possible contributing factor in 21–24% cases • Clinical diagnosis of dementia at least 60 days after last alcohol, significant alcohol use (≥35 u/wkfor males, ≥ 28 for women) ≥ 5 years, and significant alcohol within 3 years of onset cognitive deficits.
Surrey alcohol related inpatient admissions 2010/11 • 21,213 inpatient admissions • 3,596 wholly attributable to alcohol • 17,617 partly attributable to alcohol • 740 - 16-24 yr olds • 5,175 - 25-54 yr olds • 8,185 - 55-74 yr olds • 7,113 - 75+ yr olds
Cost of alcohol-related inpatient admissions by age • £1m - 16-24 year olds • £9.3m - 25-54 year olds • £17.6m - 55-74 year olds • £15.5m - 75+ year olds
Surrey 2009 • Number of deaths attributable to alcohol (all ages) in 2009 • 267 - Total • 180 - Male • 80 - Female Estimated number of deaths from chronic liver disease (all ages) per year • 94 - Total • 61 - Male • 33 - Female