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Policy Implications of drinking in later life

Policy Implications of drinking in later life. Dr Tony Rao Consultant Old Psychiatrist and Visiting Researcher South London and Maudsley NHS Foundation Trust and Institute of Psychiatry. Interpreting causality between health and drinking in later life

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Policy Implications of drinking in later life

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  1. Policy Implications of drinking in later life Dr Tony Rao Consultant Old Psychiatrist and Visiting Researcher South London and Maudsley NHS Foundation Trust and Institute of Psychiatry

  2. Interpreting causality between health and drinking in later life Older people moderate their drinking over their life course if their health declines, thereby introducing selection bias in the remaining drinkers ‘Sick Quitters’ may have determined cohort of older people at Wave 5 ELSA study finding is that drinking in later life confers no additional health benefits Abstainers in ELSA study were more likely to experience an improvement in health when compared with continuing drinkers

  3. Drinkers in later life A selective ‘super healthy’ at-risk group? ELSA study finds greater likelihood of increased drinking in older people who are well educated and have high wealth Implications for effective communication of public health messages that risky drinking behaviour may predict poor health in ‘oldest old’

  4. Partnership matters • Different consequences of losing a partner in men and women • ELSA Study highlights partnership as protective factor in men • There may be plausible reasons for reduction in drinking following • loss of partner in women • Better social engagement • Loss of ‘habit’ of drinking as ‘drinking partner’ • More likely to be prescribed benzodiazepines

  5. ‘Nanny State’ or Public health Dr Bully wants to snatch granny’s sip of sherry No doubt there are geriatric problem drinkers — but that does not justify this puritanical mass bullying When Jeanne Calment of Arles reached her 117th birthday in 1992, a local paper reported that she was being pressed by those in her nursing home to give up cigarettes — though she smoked only one or two a day — and port, which she loved. I was reminded of that hateful story last week, when the Royal College of Psychiatrists announced that people over 65 are drinking far more than is good for them, and that each day women should restrict themselves to a small glass of wine and men to less than a pint of average-strength pub beer

  6. Trends in Drinking Patterns in Older People General Lifestyle Survey (ONS, 2013) Between 2005 and 2013, percentage of men drinking 8 or more units of alcohol on any one day in past week reduced by 5% in 65+ age group 12% in 45-64 age group 19% in the 25-44 age group 30% in the 19-24 age group

  7. Older Drinkers- A Growing Public Health Burden Over 65+ age group more likely to drink on 5 or more days of the week Between 2000 and 2012, percentage of men and women in England drinking over recommended limits increased by 50% and 100% respectively Number of people aged 65 and over admitted to hospitals in England for alcohol specific disorders has increased by 40% over the past 6 years In 60+ age group and over, hospital admissions in England for mental and behavioural disorders associated with alcohol use outnumber those with alcohol related liver disease. Number of people aged 60 and over admitted to hospitals in England with alcohol related brain injury has risen by over 140% over the past 10 years, with an almost static rise in the 15-59 age group Population of aged 65+ age group and above in England and Wales increased by only 11% between 2001 and 2011

  8. Obstacles to effective communication of public health messages ‘Scandinavian’ drinking culture still exists in the UK Rationalisation such as ‘never did my dad any harm’ Understanding alcohol as a drug Risky drinking patterns vs Total amount consumed Under-reporting Health risks not always ‘causal’

  9. A Fourth Age: The Oldest Old Some evidence that older drinkers in their 70s and 80s continue to drink into their 90s Number of people aged 90+ in England and Wales accounted for 1% of the population in 2011 Oldest Old population has increased by 26% since 2002 and will continue to rise

  10. The Bigger Picture of ‘Healthy Drinking’ Cognitive disorders StrokePsychosis Depression Head, Neck, GI cancers Neuropathy Anaemia Nutritional Deficiencies Coronary Artery Disease CardiomyopathyArrhythmiaHypertension Stroke Liver Disease Cirrhosis Stomach ulcer Gastritis Pancreatitis Diabetes Duodenal ulcer

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