A L C O H O L A N D H E A LT H ALCOHOL AND SENIORS

Transcription

1 ALCOHOL AND SENIORS

2 TABLE OF CONTENTS Introduction 1 Alcohol and seniors 2 Seniors and drinking 3 Identifying drinking problems 5 Abusive and dangerous drinking 6 Research drinking 8 Recommendations 8 Éduc alcool s recommendations 9 ISBN ISBN Legal Deposit - Bibliothèque nationale du Québec, 2006 Legal Deposit - National Library of Canada, 2006

3 1 Introduction The decision to publish this brochure about drinking for people over the age of 65 was not random. Given our aging population, accurate information on such a sensitive issue is particularly necessary and relevant. The Baby Boomers are reaching the age of retirement. They are financially better off than their parents, and they have developed very different drinking habits. They are a generation looking forward to making the most of their leisure time and enjoying their retirement years to the fullest. Having more money is certainly helpful, but it offers no protection against aging-related problems. And while our increased life expectancy is excellent news, it means we must also contend with the fact that there will be a growing number of increasingly older people. The relationship between seniors and alcohol is thus a primary concern. However, given that each human being has a unique physiological and psychological profile, it is impossible to make specific recommendations about drinking that would apply to all seniors. People must be mindful about how much they drink, and seek out accurate information and advice. Determining what constitutes excessive drinking or a dangerous amount of alcohol is a process that often involves someone other than the individual senior, such as a physician, a nurse, a family member or a caregiver. This publication is therefore intended for seniors and those who care for them. In fact, family, medical professionals and caregivers must be particularly attentive when dealing with seniors. We trust that this publication will be helpful, and remind you that at any age, even and especially over 65, moderation is always in good taste. The Éduc'alcool Board of Directors

4 ALCOHOL AND SENIORS There has long been concern about young people and drinking. Now, as the Québec population ages, more attention is being paid to the issue of drinking among seniors. Until the 1950s, people over 65 accounted for only 5% of the population. Today, they constitute 14%. The proportion is expected to rise to 18% in 2016, 24% in 2026, and reach 30% in This is going to mean an increasing demand for health and social services, due, among other things, to the growing number of seniors who are drinking and having drinking-related problems.

5 3 SENIORS AND DRINKING Seniors are not a homogenous group. As with any age group, the effects of drinking on older people vary according to age, sex, socioeconomic situation and other demographic factors. In Québec, information about drinking among seniors comes from the Canadian Addiction Survey 1 and the Enquête sociale et de santé. 2 Their primary purpose is to establish a profile of the heaviest drinkers. However, in order to measure the effects of aging on drinking, we need to know whether seniors have changed their drinking habits over their lifetime, and how drinking habits have changed within a given society at a given time. In Canada, such information is hard to find. Statistics Canada has been conducting population health surveys since 1994, but that data is not public. For this brochure, we will therefore use similar studies conducted in the United States and Europe. Age Unlike previous generations, Baby Boomers in Québec grew up in a culture where drinking was very socially acceptable. The proportion of seniors who drink a lot, and perhaps too much, may therefore increase over the coming years. Drinking habits vary over time and in accordance with social norms, i.e. what is considered acceptable. Indeed, there are distinct differences in behaviour between different generations and age groups. Usually, as people age, the percentage of abusive drinkers drops. For example, in 2005, 18% of those aged 55 to 64 said they had exceeded the limits recommended by the Low-Risk Drinking Guidelines. 3 The figure drops to 11% among people 65 to 74. Nevertheless, over the last 15 years or so, drinking among seniors in Québec has been on the rise. Comparing the 1998 Enquête sociale et de santé data with that of the 1987 and 1992 surveys, we see a drop in the number of abstainers among those over 65: 36% in 1987, 38% in 1992 and 30% in There is also a decline in the number of people who have stopped drinking: 13% in 1987, 10% in 1992 and 12% in These same studies show an increase in the number of older drinkers: 52% in 1987, 52% in 1992 and 59% in From 1987 to 1998, the average number of drinks per week rose from 5.5 to 6.3 among men, although women reduced their intake from an average of 2.5 to 2 drinks a week. One American study shows that generations with a high rate of abusive drinking during their youth also have the greatest number of alcohol-related problems later on. 1 Adlaf, E.M., Begin, P., & Sawka, E. (Eds.). (2005). Canadian Addiction Survey (CAS): A national survey of Canadians' use of alcohol and other drugs: Prevalence of use and related harms: Detailed report. Ottawa: Canadian Centre on Substance Abuse. 2 Chevalier, S., and Lemoine, O. (2000). Consommation d'alcool in Enquête sociale et de santé 1998, 2 nd edition, Québec, Institut de la statistique du Québec, chapter 4. 3 Canada s Centre for Addiction and Mental Health - CAMH).

6 4 Sex Twice as many men as women 30% compared to 15% exceed the limits recommended by the Low-Risk Drinking Guidelines. As for abusive drinking, 15.7% of older men in Québec say they have more than 14 drinks a week, compared to only 3.8% of older women. And yet, from 1987 to 1998 in Québec, the greatest increase in average number of drinks per occasion occurred among women 45 to 64. This means that we might see a change in drinking among older women over the coming years. Socioeconomic status According to the two studies mentioned above, the people who drink the most are the ones with the most money. Significantly more high-income Canadians (27.4%) say they have exceeded the limits recommended by the Low-Risk Drinking Guidelines, compared to 22.3% of those with an average income and 20.5% of low-income individuals. In Québec, a higher proportion of people with aboveaverage incomes have more than 14 drinks a week. The link between income and drinking is evident. We may therefore expect to see an increase in drinking among seniors, given that the Baby Boomers about to hit their sixties are wealthier than any previous generation at that age. Marital status and living arrangements The above-mentioned studies contain data on drinking habits according to marital status and living arrangements. Unfortunately, that data has not been analyzed by age group, and we have no way to draw conclusions about Québec seniors based on whether they are married, divorced, widowed or single, living alone or not.

7 IDENTIFYING DRINKING PROBLEMS In Canada, 11% to 14% of seniors drink more than the limit recommended by the Low-Risk Drinking Guidelines. Last year, 2.8% of seniors said they had a least one problem related to their drinking. It is the same in the United States and Europe, where 15% of men and 12% of women drink more than the recommended low-risk limit: 2% to 6% drink abusively and 1% to 3% suffer the consequences of abusive drinking. Studies indicate that 6% to 11% of all seniors admitted to hospital in developed countries show signs of alcoholism. Many experts believe that the number of seniors with alcohol-related problems is probably much higher than the research shows. Since we appear to underestimate the number of alcohol-related problems in all age groups, the same is likely to be true for seniors. Drinking problems are difficult to identify Family members, friends and health care professionals all avoid identifying or fail to identify drinking problems among seniors. The tendency appears to be to want to protect people because of their age. Seniors often suffer from various ailments that are caused by abusive drinking. Such things as a general decline in health, introversion, memory loss, depression, insomnia, falls, digestive problems, loss of appetite and anxiety are more frequently diagnosed as the result of an illness or simply due the aging process. Inadequate diagnostic tools The tool 4 generally used to diagnose alcohol-related problems in seniors are not always reliable because they tend to focus on current drinking, whereas, with seniors, we need a clear picture of their drinking habits over the course of their lifetime. The commonly used diagnostic tools place too much emphasis on the social, occupational and legal consequences of drinking problems associated primarily with younger people, and fail to adequately address the health and social issues experienced by seniors. 4 Such as AUDIT and CAGE

8 ABUSIVE AND DANGEROUS DRINKING 6 Life-changing events can occasionally lead to abusive drinking, and the specific living conditions of seniors can sometimes result in dangerous drinking. The difference between abusive and dangerous drinking is one of intent: abusive drinking is intentional, whereas dangerous drinking is not. An abusive drinker is someone who persists in drinking too much, or badly, knowing that this can have a negative physical, physiological or social impact. A dangerous drinker is generally someone who is inattentive and uninformed. This is often the case of seniors, which makes them vulnerable to alcohol-related problems. Finding a solution to a dangerous drinking situation may require the involvement of a doctor, nurse, family member or caregiver. Risk factors for abusive drinking While the research mentioned above identifies the factors associated with abusive drinking, it does not indicate why some older people drink abusively. Moreover, no distinction is made between seniors who have had a drinking problem for years and those who develop problems after the age of 60. For the vast majority of seniors, these events do not lead to drinking problems. In fact, they often result in decreased drinking. But for others, they are significant risk factors for abusive drinking. Retirement Some seniors welcome retirement with open arms. However, for people who have never developed hobbies or interests or a network of friends outside of work, retirement entails a host of losses: there s the loss of a routine, co-workers, something to do, a salary, the sense of being useful, etc. Work is what has given their lives meaning, goals and structure. Some people begin drinking excessively in response to this overwhelming sense of loss. Some are simply unable to adjust to the loss of structure and drink to relieve the boredom. Others find themselves faced with an increasing number of social activities where alcohol is very present. It is estimated that, among seniors who drink abusively, one-third developed a drinking problem after the age of 60, often because of difficulty adapting to problematic life-changing events. Retirement, changes in family relationships and health issues can all lead to drinking problems in seniors. Such changes are experienced as losses and cause emotional and physical pain. People of all ages experience loss, but with seniors, such losses are often irreversible and can be cumulative. Drinking can be seen as justified by the loss, which is frequently experienced as mourning or stress, with an associated feeling of powerlessness.

9 7 Social and family ties Children leave home, friends and spouses die, social circles become smaller. And seniors often have physical problems that can limit their mobility. All this accentuates the sense of isolation and solitude, which may become intolerable. Unlike younger people, who tend to drink because they are among friends, seniors tend to drink because they are alone. The loss of a spouse can be particularly devastating, and lead a person to drink excessively in an attempt to relieve the pain. Health Losing one s health can result in stress caused by limited mobility and a diminished sense of self. Some people may use alcohol to dull the pain associated with the loss of their physical capacity. Some seniors who live with severe chronic pain may use alcohol to relieve their discomfort. Other factors Other factors help explain why some seniors react to certain situations by drinking more, while others handle the same situations without increasing their alcohol intake. These can include the following: drinking more to help handle difficult situations or events; the lack of coping mechanisms other than alcohol; the lack of a good social network; living alone and being isolated; having had drinking problems in the past. Risk factors for dangerous drinking One of the most important risk factors for dangerous drinking among seniors a factor almost exclusive to seniors is the combination of alcohol and medication. The normal aging process entails certain physiological changes that make seniors more vulnerable to the effects of alcohol and make them more likely to drink dangerously. Alcohol and medication Alcohol is counter-indicated for many medications. In Québec, over the course of a single year, 74% of all seniors take at least one prescription drug. Multiple prescriptions are also very common: in 1998, 52% of seniors regularly took at least three prescription drugs, and 20% took at least 5. 5 Alcohol can heighten the sedative effect of medications like benzodiazepines and increase the risk of falls. When alcohol is taken with drugs prescribed for epilepsy, high blood pressure and even the common cold, it can cause drowsiness and confusion. Serious physical and psychological problems can occur when alcohol is combined with medication for rheumatism, arthritis, pain, infections and depression. Poor communication Insufficient information, poorly understood information and improperly used information are other important risk factors in dangerous drinking related to the combination of alcohol and medication. Information problems generally result from poor communication between doctor and patient. Seniors sometimes keep important details from their doctors, believing that their symptoms are part of the normal 5 Conseil des aînés (2005). Avis sur l'utilisation optimale des médicaments par les aînés, presented to Ms. Carole Théberge, Minister Responsible for Seniors, and Mr. Philippe Couillard, Minister of Health and Social Services, Québec, 13 pp.

10 8 aging process. They may assume there is no treatment or remedy. They don t know what s causing their symptoms, and sometimes they simply don t want to bother their doctor. It has been noted that, even though seniors go to the doctor with more problems than other patients and take more time giving and receiving information, physicians tend to spend less time with older patients. Physicians are also more likely to prescribe more medications spontaneously for seniors than for their younger patients. Physiological vulnerability As people age, the body s fat-to-water ratio changes, with fat content increasing and water content decreasing. Also, alcohol dehydrogenase, a critical enzyme involved in the metabolism of alcohol by the liver, becomes less efficient over time. Consequently, all other things being equal, an older person who drinks the same amount as a younger person will have a higher blood-alcohol level. As the body ages, changes occur in the kidneys, the liver, the cardiovascular system and the brain. Alcohol is eliminated less efficiently, which can result in increased sensitivity to its effects. These changes become more noticeable over time, so that the effects of drinking become more RESEARCH ON DRINKING A growing number of researchers are becoming more interested in drinking and seniors, particularly people who develop drinking problems after the age of 60. Studies on life changes have identified the social events likely to have an impact on drinking among seniors, but there is little data available in Canada on the effects of aging on drinking. Social changes involving loss may well lead to drinking problems, but the relationship between the kinds of stress resulting from such loss and drinking behaviour is still not clearly understood. The difference between abusive and dangerous drinking among seniors is significant. An older person s overall physiological vulnerability and alcohol s incompatibility with many of the medications taken by seniors increase the risk of harmful effects from excessive drinking. RECOMMENDATIONS As the population ages, we can expect an increase in the number of seniors with alcohol-related problems. The Baby Boomers now entering their sixties are generally financially well off. They have also grown up in a society with a permissive approach to alcohol. Both factors contribute to the increased likelihood of problems related to excessive drinking among seniors. It is therefore extremely important to make seniors aware of the dangers of abusive and dangerous drinking. This applies particularly to people whose drinking habits may unintentionally put them at physical or psychological risk. Some organizations in other countries have made specific recommendations with regard to seniors and drinking. The Institut suisse de prévention de l'alcoolisme (Swiss institute for alcoholism prevention) says that, as they age, men in good health should not have more than two standard drinks day, and women should not have more than one.

11 9 The Fondation vaudoise contre l'alcoolisme (a foundation that combats alcoholism in the Swiss canton of Vaud) defines abusive drinking among people over 65 as seven or more standard drinks a week, and three or more standard drinks per social event. Similarly, the National Institute on Alcohol and Alcoholism in the United States recommends a limit of one standard drink a day for both older men and older women. In Canada, researchers have been trying to decide whether there is reason to make specific recommendations for seniors. In the end, they have concluded that age alone does not justify recommending anything other than the standard approach of moderation recommended for the general population. Age is one factor among others, including general health and the use of medication. Specific restrictions on drinking should therefore be made on a case-by-case basis. ÉDUC ALCOOL S RECOMMENDATIONS Alcohol dependency causes suffering at any age. If we wish to ensure the dignity and well-being of seniors, we would do well to take a preventive approach and watch for potential problems rather than turn a blind eye. Pay attention Changes in the body s fat-to-water ratio and a slower metabolism can produce a higher blood-alcohol level in seniors than among younger people of the same weight who drink the same amount. Éduc'alcool recommends that people over 65 be attentive to how they respond to alcohol and adjust their drinking accordingly. Alcohol and medication Seniors tend to take more medications than younger people, and alcohol and drugs are often a very bad mix. Éduc'alcool recommends that anyone over 65 who receives a prescription check immediately with their physician or pharmacist to see whether alcohol is contra-indicated. A vigilant community Seniors are at risk for unintentional dangerous drinking, and drinking problems can masquerade as symptoms often associated with aging. Éduc'alcool recommends that the caring community of people over 65 family, friends, physicians and health-care professionals be informed, watchful and quick to take action.

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