02Nov15 - Drink Wise Age Well programme launch

Drink Wise, Age Well Monday 02nd November 2015

#DrinkWiseAgeWell

Welcome

Simon Antrobus

CEOAddaction

#DrinkWiseAgeWell

Why ‘Drink Wise, Age Well’ ?

Partnership Approach

Is alcohol and ageing an issue? The most significant increases in alcohol-related harm in

recent years have occurred in older people

1 in 3 alcohol problems in older people occur for the first time in later life, therefore it is never too late for prevention

Alcohol problems are less likely to be detected in older people

Older people are more likely to be treated successfully for an alcohol problem than younger people

Helping people make healthier choices about alcohol as they age

Prevention and Campaigning Training and Skills Development Building Resilience Direct Engagement and Support

Numbers Recap• £25 million grant • 7 years ( 5 operational)• 5 demonstration areas• 6 Strategic Partners • 19 Portfolio Projects • 89 Drink Wise Age Well staff

Dr Sarah Wadd

DirectorSubstance misuse and Ageing Research Team at the

Tilda Goldberg Centre, University of Bedfordshire

#DrinkWiseAgeWell

Evidence, Research

and Evaluation

England, 2015

Extent of the Problem

• 25% of men and 16% of women aged 50+ exceed recommended weekly limits

• 33% of men and 23% of women aged 50+ exceed recommended daily limits

Health Survey for England, 2013

50-59 60-69 70-79 80+0

5

10

15

20

25

30

35

MenWomen

Per c

ent


Exceeding Recommended Weekly Limits

What proportion of people with alcohol problems are 50+

• Amongst men, half of harmful drinkers (50%) and just under half of hazardous drinkers (48%) are 50+

• Amongst women, 43% of harmful drinkers and 43% of hazardous drinkers are 50+


Alcohol-Related Hospital Admissions, England

Source: Wadd, 2012

2002 2003 2004 2005 2006 2007 2008 2009 20100

2,000

4,000

6,000

8,000

10,000

12,000

25-3435-4445-5455-6465-7475+

Rate

per

100

,000

pop

ulati

on

Drink Wise, Age Well Questionnaire Study

• Questionnaire sent to over 50’s before and after programme

• Demonstration and control areas• More than 17,000 people aged 50 and

over completed questionnaire• Only survey specifically designed to

examine drinking behaviour in later life worldwide

Betty: Aged 72, retired, widowed, lives alone

• Drinks 2-3 times a week, more than 10 units on a typical day• On weekly basis not able to stop drinking when started and had a

feeling of guilt or remorse after drinking• Drinks because she likes the way it makes her feel, to take her mind

off problems, when she feels down or depressed, when she feels lonely or bored

• Alcohol impacts negatively on her energy levels and mood• She is not coping with stresses in life, is not happy with life, doesn’t

get the emotional help she needs from her family, doesn’t have a special person that she can share her joys and sorrows with, doesn’t engage in activities that she find enjoyable and fulfilling

• Not confident in her ability to calculate or keep track of alcohol units• Wouldn’t tell someone if she had an alcohol problem• Thinks that people with alcohol problems have themselves to blame

David: Aged 52, working

• Drinks 4 or more times a week, 100 units in last seven days

• Drinks because likes the taste of it, likes the way it makes him feel, to be sociable and to relax

• Not worried about his drinking• Does not know what recommended daily limits

are• Not been asked about alcohol use in last 12

months

Other research and evaluation

• Interviews/focus groups with people who have received interventions including repeat interviews/focus groups to get sense of impact over time

• Interviews with stakeholders and DWAW staff to find out to find out what is (and isn’t working well) and what could be improved

Other research and evaluation

• Routine data gathering throughout for example number of people who have positive cognitive impairment screening test

• Before/after survey to measure professional capacity and confidence (knowledge, skills and networks) in recognising and responding to alcohol problems in over 50’s

Special Focus Sheffield - Ethnicity

• Minority ethnic groups have similar levels of alcohol dependence despite drinking less

• Minority ethnic groups are under-represented proportionately in seeking treatment and advice for alcohol problems

• People belonging to minority ethnic groups with strong religious ties that forbid drinking may hide their drinking for fear of repercussions and bringing shame on their families

Evaluation Ethnicity

• Routine data monitoring to ensure minority ethnic groups are accessing services

• Explore extent to which interventions are accessible and culturally sensitive to needs of minority ethnic groups in interviews and focus groups

• Analysis of survey data to see if programme has had the same impact on minority ethnic groups

Special Focus Devon - Lifestage

• People at different lifestages have different needs

• Those entering old age may need help preparing for life-transitions such as retirement and ‘empty-nest’ syndrome

• ‘Older olds’ may be housebound or require information in different formats e.g. enlarged print

Evaluation Lifestage

• Routine data monitoring to ensure people from all age groups are accessing services

• Extent to which interventions meet the needs of people from different lifestages explored in interviews and focus groups

• Analysis of survey data to see if programme has had the same impact on people at different life stages

Dr Kieran Moriarty

Consultant Physician and GastroenterologistBolton NHS FT

#DrinkWiseAgeWell

ALCOHOL – RELATED PROBLEMS IN OLDER PEOPLE: CLINICAL FEATURES,

PRESENTATIONS AND VULNERABILITY

DR KIERAN MORIARTYCONSULTANT

GASTROENTEROLOGISTROYAL BOLTON HOSPITAL

ENGLAND

Prevalence Alcohol Problems in Older People

• A & E Departments….. 14%

• Medical inpatients……. 6-11%

• Psychiatric inpatients… 20%

• Nursing home patients.. Up to 49%

Early v. Late Onset AlcoholismEarly onset:• Describes those who have a lifelong pattern of drinking, have

probably been alcoholic all their life, and are now elderly.• More likely to have chronic alcohol-related medical problems such

as cirrhosis, organic brain syndrome, and co-morbid psychiatric disorders.

Late onset:• Describes those who have become alcoholic in their drinking

pattern for the first time late in life. • Often triggered by a stressful life event. • Generally represented by milder cases with fewer accompanying

medical problems. • More amenable to treatment, more likely to have spontaneous

recovery, but also more likely to be overlooked by health care professionals (Liberto & Oslin, 1995).

Older Drinkers - Reasons

• Habitual• Boredom• Anxiety• Depression• Insomnia• Grief• Loneliness• Ill health• Pain

Signs & Symptoms• Anxiety• Blackouts, dizziness• Depression• Disorientation• Mood swings• Falls, bruises, burns• Family problems• Financial problems• Headaches• Incontinence

• Increased tolerance • Legal difficulties• Memory loss• New problems in

decision making• Poor hygiene• Seizures, idiopathic• Sleep problems• Social isolation• Unusual response to

medications

Diagnosis Issues

Practitioner Barriers to Identification

• Ageist assumptions• Failure to recognize symptoms• Lack of knowledge about screening• Physician discomfort with substance abuse

topic- 46.6% of primary care physicians found it difficult to discuss prescription drug abuse with their patients

(CASA, 2000)

Individual Barriers to Identification

• Attempts at self-diagnosis • Description of symptoms attributed to ageing

process or disease• Many do not self-refer or seek treatment

- Although most older adults (87 percent) see physicians regularly, an estimated 40 percent of those who are at risk do not self-identify or seek services for substance abuse

(Raschko, 1990)

Physiological Changes with Age

Decreased Lean Body Mass

Decreased TotalBody Water

Decreased GastricEtOH Dehydrogenase

Increased Serum EtOH for agiven dose

Relative Risks of Mortality from Coronary Heart Disease by Level of Alcohol Intake

Source: Britton derived from meta-analysis by Corrao et al. (2000)

Alcohol Consumption and Annual Risk of Death

Rehm et al, 2011

ALCOHOL ADMISSIONS-PRIMARY REASONS ( > 60 YEARS OLD)

Alcohol and Stroke

• ISCHAEMIC STROKE- Mild-mod consumption reduces risk- Heavy consumption increases risk (but cigarettes and blood pressure

confound)

• HAEMORRHAGIC STROKE- More frequent for regular (>40g/d) and binge drinkers

Alcohol and Musculoskeletal System

• Most important effect is through violence and falls• Chronic alcohol misuse leads to:

- Osteoporosis- Reduced calcium and magnesium- Depressed 25-hydroxyvitamin D- Myopathy

Alcohol and the Nervous System

• Behavioural changes of intoxication• Acute alcohol withdrawal syndromes• Wernicke’s encephalopathy/Korsakoff’s syndrome• Peripheral neuropathy• Dementia

ALCOHOL – DRUG INTERACTION

• Prescribed- hypnotics, anxiolytics, opioids, antibiotics, anticoagulants, anti-depressants, epileptics, hypertensives

• Over the counter – painkillers

• Illicit

ALCOHOL AND CO-MORBIDITY

• Ageing – “silent epidemic”• Smoking – Cancer, Pneumonia, TB• Hypertension• Malnutrition• Obesity• Dementia• Psychiatric• “Dual diagnosis”

Older Persons Concerns about Treatment:

• Treatment takes too long• It’s embarrassing to tell people• Treatment is just for kids• Treatment is just for addicts• Treatment is too expensive• Being away from home

Don Lavoie

Alcohol Programme Manager, Alcohol TeamPublic Health England

#DrinkWiseAgeWell

Drink Wise

Age Well

Don Lavoie – Public Health England

Drinking “At Risk” groups

44 PHE Drink Wise Age Well

Source: Health Survey for England 2013 (ONS) & Adult Psychiatric Morbidity Survey 2007

7.6m17%

7.4m17%

1.6m4%

27.7m64% 6.7m

15%

1.7m4%

Hazardous and harmful drinking (APMS)


Alcohol dependence (APMS)


AUDIT Scores (APMS)


Binge drinking


Men – drinking 5+ days (GLS ONS)Drinking in the last week

20051 20062 20072 20082 20092 20102 20112

PercentagesMenDrank last week

16-24 64 60 64 63 55 49 5225-44 74 73 74 72 70 69 6745-64 77 76 76 74 72 73 7265 and over 66 67 67 66 66 65 63

Total 72 71 72 70 68 67 66

Drank on 5 or more days last week

16-24 10 8 9 6 7 5 525-44 18 17 18 14 13 12 1145-64 28 26 27 24 23 20 2265 and over 26 27 29 27 27 26 24

Total 22 21 22 19 18 17 16


Women – drinking 5+ days (GLS ONS)Drinking in the last week

20051 20062 20072 20082 20092 20102 20112

PercentagesWomen Drank last week

16-24 56 53 54 52 51 46 5025-44 62 60 61 59 59 56 5645-64 61 61 61 60 59 60 6065 and over 43 44 45 43 43 43 42

Total 57 56 57 55 54 53 54

Drank on 5 or more days last week

16-24 5 3 4 2 2 2 325-44 11 9 11 9 7 7 645-64 17 15 15 15 14 13 1265 and over 14 15 15 15 14 14 13

Total 13 11 12 11 10 10 9




Burden of disease attributable to 20 leading risk factors for both sexes in 2010, expressed as a percentage of UK disability-adjusted life-years

*

]

Burden of diseased 2013


Alcohol-related deaths and morbidity

21,485 deaths were attributable to alcohol in England in 2011-12 alcohol-related hospital

admissions in 2012-13, 350,000 where an alcohol-related condition or cause was the main reason for admission.

1 million


3 “Ages” of alcohol harm


0 10 20 30 40 50 60 70 AGE Younger people Middle age Older people

FREQUENCY OF HARM

ACUTE HARM – accidents, poisoning ACUTE DISEASE – liver, pancreasATTRIBUTABLE HARM – cancers, heart disease

Alcohol - adds to health risks



QOF registers and risky drinking


Alcohol-related hospital admissions in Torbay


Alcohol-related hospital admissions in Torbay


Conclusions CMOs currently looking at “sensible drinking message” and lower-risk

guidelines. This may set different limits for older people and other groups

Older people are responsible for most partially attributable alcohol-related hospital admissions, but less wholly attributable alcohol-related hospital admissions

There are a number of opportunities to intervene:NHS Health CheckSelective QOF Registers

HypertensionDepression

Making Every Contact Count


Professor José Iparraguirre

Chief EconomistAge UK

#DrinkWiseAgeWell

Prof. José Iparraguirre

Chief Economist, Age UK

Monday, 2 November 2015

Socioeconomic determinants of risk of harmful alcohol drinking among people aged 50 or over in England

BMJ Open 2015 5 e007684 doi:10.1136/bmjopen-2015-007684

1. Literature Review

a. Only reviewed papers on determinants b. Identified covariates: Age, Gender, Depression, Loneliness, Income, Education, Marital Status, Smoking, Dietary Habits, Social Ties, Physical Activity, Self-reported health, Co-habitation

c. Abstainers as different group

2. Data

NICE guidelines:

Lower-risk drinking: ≤ 21 units per week (adult men) or ≤ 14 units per week (adult women).

Increasing-risk drinking: 22 ≤ 50 units per week (adult men) or 15 ≤ 35 units per week (adult women).

Higher-risk drinking: > 50 alcohol units per week (adult men) or > 35 units per week (adult women).

2. Data

Three alternative conversion tables:

• NHS ‘alcohol unit calculator’ • 2007 General Lifestyle Survey• drinkaware website

2. Data

2. Data

English Longitudinal Survey of Ageing (ELSA)(Wave 5) – For transition study, Waves 4 and 5

Sample population aged 65 or over5,071 cases with full records

Variables included:Age, Income, Education, Smoking, Physical Activity,Depression, Loneliness, Self-Reported Health,Ethnicity, Gender, Marital Status

3. Results

3. Results

Risk increases:

The younger the personThe higher their income The more educatedThe more physically activeThe better the self-reported health statusAmong White people (against non-whites)Among Males Among Widowers (against Widows, not against other Marital Status irrespective of gender)

3. Results

Conditional probability plot of being at higher risk drinking category by age and gender

The non-linear association with age and the associated finding that, for men, the probability of being in the higher risk category peaks in the mid-60s could give empirical support to the hypothesis that current cohorts of older people are carrying on the relatively higher consumption levels they exhibited earlier on in their lives into older age compared to previous cohorts.

3. Results

3. Results (transitions between risk categories)

(Excerpt)

For women not classified as higher risk drinkers in W4:- being lonely- being younger and - having a higher incomeare associated with a higher probability of becoming a higher risk alcohol drinker in W5.

Observing a healthy diet is associated with a lower probability of becoming a higher risk alcohol drinker.


For men not classified as at higher risk in W4:- not eating healthilyis associated with a higher probability of becoming a higher risk alcohol drinker in W5- having children living in the household increases the likelihood of ceasing to be at higher risk by W5


The older they are, the less likely they may become higher risk drinkers, and for those at a higher risk category, the more likely it is that they may cease to be so. The higher their income, the more likely they may become higher risk drinkers if they were not so, and the less likely that they cease to be higher risk drinkers if they were so.

People• in better health, • with higher income, • higher educational attainment and • socially more active are more likely to drink at harmful levels

4. (Main) Conclusion

4. (Unpleasant) Corollaries?

Consequently,

1. Is the problem of harmful alcohol drinking among people aged 50 or over in England a middle-class phenomenon?

2. Are those ageing ‘successfully’ developing harmful drinking consumption patterns?

Prof. José Iparraguirre

Chief Economist, Age UK

Monday, 2 November 2015

Socioeconomic determinants of risk of harmful alcohol drinking among people aged 50 or over in England

Panel Debate and Q&A

• What are the age-specific problems associated with harmful drinkers in the over 50s population?

• How can we best promote a healthier relationship with alcohol in the over 50s population?

• Can you envisage any challenges to the project?

• How can we raise the profile of this issue amongst policy makers?

#DrinkWiseAgeWell

Drink Wise, Age Well Monday 02nd November 2015

#DrinkWiseAgeWell

Healthcare

02Nov15 - Drink Wise Age Well programme launch