Introduction

1. ALCOHOL-RELATED MORTALITY AND MORBIDITY AMONG ELDERLY FINNISH POPULATION. A GROWING ALCOHOL POLICY PROBLEM?Salme Ahlström and Pia MäkeläPaper to be presented at the NORDIC ALCOHOL AND DRUG RESEARCHERS’ ASSEMBLY, August 23 – August 25, 2010, Reykjavik, Iceland

2. Introduction • Senior European population has grown more than twice as fast as the overall population since the early 1980s. • With this demographic shift, there has been a growing awareness of the importance of older adults' needs in many areas. • Alcohol-related problems can begin later in life and due to higher vulnerability, drinking amongst the elderly can • increase susceptibility to falls and other injuries • reduce the effectiveness of prescribed medication • cause a range of physical, mental and social difficulties resulting in increased use of services and costs.

3. Focus of presentation • Background • Data and methods • Trends in Alcohol-related Harms • Alcohol-related deaths • Clients in institutions that provide care for substance use • Alcohol-related hospitalizations • Conclusions

4. Background I • Between 1998 and 2007, total per capita alcohol consumption (both recorded and estimates of unrecorded consumption) increased 19 per cent in Finland, with the highest increase recorded between 2003 and 2004.

5. Background II • This change was attributable to several factors. • In January 2004, quotas for travellers’ tax-free alcohol imports from other European Union Member States were abolished. • In March 2004, the prices of alcoholic beverages were lowered by 33 per cent on average • The relative decrease was higher for strong alcoholic beverages (44 per cent) than for beer (32 per cent) and wine (10 per cent). • In May 2004, Estonia joined the European Union, and thereafter Finnish travellers could benefit of the lower alcohol prices in Estonia.

6. Data and Methods • The analysis is based on statistics of • (1) Alcohol-related mortality: alcohol attributable diseases and fatal alcohol intoxication; accidental and violent deaths with alcohol intoxication as a contributory cause (Statistics Finland) • (2) Clients in institutions that provide care for substance abusers (OSF. THL. Institutional Care and Housing Services in Social Care) • (3) Alcohol-related hospitalizations. (OSF. THL. Inpatient Health Care). • The analysis comprises all over 60 year-old Finns in 1998-2007. • Statistics were calculated per 100 000 inhabitants by gender and age group.

7. Figure 1. Alcohol-related mortality: alcohol attributable disease or poisoning per 100 00 inhabitants by age group among women, in 1998-2007

8. Figure 2. Alcohol-related mortality: alcohol attributable disease or poisoning per 100 000 inhabitants by age group among men, in 1998-2007

9. Figure 3. Accidental and violent deaths with alcohol intoxication as a contributory cause per 100 000 inhabitants by age group, in 1998-2007, women and men

10. Figure 4. Female clients in institutions that provide care for substance abusers 1)per 100 000 inhabitants by age group, in 1998-2007 1) Institutions providing care that entitels to the rehabilation allowance granted by the social insurance Institution and all detoxfication centres.

11. Figure 5. Male clients in institutions that provide care for substance abusers 1)per 100 000 inhabitants by age group, in 1998-2007 1) Institutions providing care that entitels to the rehabilation allowance granted by the social insurance Institution and all detoxfication centres.

12. Figure 6. Alcohol-related hospitalizations per 100 000 inhabitants by age group among women, in 1998-2007

13. Figure 7. Alcohol-related hospitalizations per 100 000 inhabitants by age group among men, in 1998-2007

14. Conclusions I • Alcohol-related harms among elderly Finnish population have increased profoundly and notably more than in younger age cohorts. • Especially, among women aged 60 to 69, the rates of alcohol-related mortality and morbidity have increased significantly. • However, the elderly population is not homogenous. The increases took place mainly in age groups younger than 70.

15. Conclusions II • In 2007, the age cohorts born between 1945 and 1947 were respectively 60, 61 and 62 years-old. • These cohorts are part of the Finnish baby boomers, born between 1945 and 1950. • The baby boomers grew up in a very different world from the generation that immediately preceded them – those currently in old age. • Those who are now over 70 were raised at a time when alcohol consumption in Finland was at a low point.

16. Conclusions III • Since the 1960s there has been an almost uninterrupted increase in per capita consumption in Finland. • During the past 50 years alcohol has become more available, less controlled, and relatively cheaper. • The impact of this change has been most evident for women, who attained greater spending power and independence at work and leisure. • Baby boomers have lived within an environment of acceptance and encouragement of alcohol use that was not evident for earlier generations.

17. Conclusions IV • Cross-sectional research suggests that as people age they reduce their alcohol intake. • However, the problem with this research is that it is impossible to separate ageing effects from cohort and period effects. • Thus, it may be that the current cohort of old people may have consumed much less when younger and middle aged and have carried this pattern into old age.

18. Conclusions V • If the baby boomers start with a higher level of consumption, reduction of intake may still leave them consuming at levels that will put their health at risk in old age. • If they, because of their relative wealth in retirement, combined with more time during the day to consume more alcohol, continue to drink at their current levels, the impact will be even greater – quite a dramatic increase in alcohol-related mortality and morbidity and economic costs.