Mention hazardous drinking and most of us imagine teenagers or students getting drunk, causing havoc and filling our emergency departments on a Friday night.
But what if I told you that we should be just as worried about how much our parents and grandparents are drinking?
Our latest research shows that up to 40% of adults aged 50 and over are hazardous drinkers. This increases to almost 50% for men in this age group.
Alcohol-related risk for older adults
Alcohol is the drug of choice for baby boomers. However, the older we get the lower the threshold for hazardous drinking is for two key reasons. First, ageing bodies can’t process alcohol as well as they used to so we get drunk faster and feel the effects more. Second, the older we get the more likely we are to have developed health conditions that alcohol exacerbates and to use medication that alcohol can interfere with.
Despite the heightened risks, we know older adults are less likely to be screened for alcohol than other groups. Further, when screening occurs, it usually ignores the combined health and medication risk factors that place older drinkers at such high risk.
Our research aimed to answer three simple questions: How many older adults are hazardous drinkers? Who is most at risk of harm? Where can we find them?
We used data from more than 4,000 New Zealanders aged 50 and over in the government-funded Health, Work and Retirement study at Massey University. We compared the number of hazardous drinkers identified on two different screening tests: a standard screening and one specific to older adults.
The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is a standard screening for primary health care. It assesses how often you drink, how much you drink, and how often you binge (have six or more drinks). You are a hazardous drinker if your drinking pattern puts you at risk of harm immediately (weekly binge drinking) or in the long-term (frequent moderate drinking).
The Comorbidity Alcohol Risk Evaluation Tool (CARET) is a screening specific to alcohol-related harm for older adults. It assesses drinking patterns but modifies the allowable drinking frequency, quantity and binge limits based on the presence of health conditions and health issues that alcohol can make worse, and medication that alcohol can interfere with.
First, we found that 83% of older New Zealanders in this sample were current drinkers, while 13% were past drinkers who no longer drank, and 4% were lifetime abstainers.
Second, we found the CARET classified 35% of the sample as hazardous drinkers compared to 40% on the AUDIT-C. The higher proportion on the AUDIT-C resulted from our use of a stricter threshold for hazardous drinking than used on the CARET.
Approximately 10% of non-hazardous drinkers on the AUDIT-C were classed as hazardous on the CARET because despite their low levels of alcohol use their existing ill health and medication use made any drinking potentially harmful.
Most at risk of harm
We were able to identify key characteristics of older drinkers who were hazardous in both tests or one test only.
Hazardous drinkers on both screens were predominantly healthy men who drank high amounts of alcohol very frequently, with monthly binge drinking
hazardous drinkers on AUDIT-C only were healthy men and women who drank small amounts of alcohol very frequently, with some binge drinking
hazardous drinkers on CARET only were unhealthy men and women who drank small amounts of alcohol frequently, with little or no binge drinking.
This suggests GPs and practice nurses need to understand even older adults in good health require screening for their alcohol use, particularly older men. Further, any indication of very frequent drinking (five or more times a week) and binge drinking is a flag for concern.
Any older adults in poor health definitely require screening for alcohol use as any level of consumption may be dangerous.
Where are the older hazardous drinkers
For a GP or a practice nurse, older hazardous drinkers will be some of their most frequent patients. We found the majority of older hazardous drinkers saw their GP three or more times a year. Approximately 60% of drinkers whose ill health places them most at risk of harm actually visit their GP almost once a month.
International research shows health professionals are reluctant to talk to older adults about their drinking, older adults are less likely to be screened for alcohol use, and younger adults are prioritised for treatment. But the results of our study suggest the GPs office is the ideal setting to start this conversation about alcohol with older adults.