A hidden problem: Alcohol and older adults
Alcohol misuse among older adults is gaining attention as one of the most critical health issues impacting quality of life in the later years and is poised to become an even bigger issue. More Ontarians turn 65 each year and the number of seniors in the province is projected to almost double by 2041.¹ We are living longer and many older adults are enjoying good health. Despite this upbeat news a growing number are living with alcohol misuse problems.

We might think that this life stage is hardly the time to address Grandpa Jack’s long-term drinking problem. And as for Aunt Carrie’s daily tipple since her husband passed away, who could deny her a little comfort in her twilight years? But the reality is that far from improving their lives, alcohol has the potential to rob older adults of their health and well-being.

Statistics show that 23.6 per cent² of Ontario adults 65 and over exceed the Low Risk Alcohol Drinking Guidelines, and 5.2 per cent³ report heavy drinking. And while these rates are lower than those for younger adults, there is cause for concern. The potential impacts on older adults are serious and often overlooked as seniors go underdiagnosed and undertreated.

Unique vulnerabilities
As people age, physiological changes occur that result in lowered tolerance to the physiological effects of alcohol.⁴ This sensitivity increases the risk of falls and worsening health problems for older adults who drink alcohol. Older adults are also much more likely to be taking medications for chronic illnesses which can combine harmfully with alcohol. Even moderate alcohol use has the potential to put older adults at risk.  

Of older adults who do misuse alcohol, it’s estimated that one third developed a drinking problem after the age of 60.⁵ Older adults experience any number of stressors such as declining health or loss of a spouse, and may turn to alcohol to cope with physical or emotional pain.⁶ Those who use alcohol to “self-medicate” are more likely to report loneliness and low life satisfaction.⁷

A hidden problem
Alcohol misuse among seniors has been called an “invisible epidemic”.⁷ So why aren’t we paying more attention?

Ageism likely plays a role – the pervasive assumption that changes in health status experienced by older adults are just a part of the ageing process, or that it’s not worth treating because the outcomes would be limited.⁸ On the contrary, older adults being treated for substance use problems have as good or better outcomes than their younger counterparts.⁷

Another likely culprit is a lack of awareness among family members, care-givers and clinicians, compounded by the stigma so often associated with alcohol misuse. Those who are in a position to intervene may not have the knowledge, tools and helping resources to recognize and adequately address substance use problems among older adults.

Enhancing quality of life
Addressing the causes and consequences of alcohol misuse among older adults is becoming more urgent, and a growing number of researchers and clinicians are working to shine a light on the issue. Progress here has potential to assist older adults in weathering the often life-changing events associated with ageing and to significantly enhance quality of life in the later years.

References
^1. Ontario Ministry of Finance. Ontario population projection update: Spring 2016. Ontario: Queen’s Printer for Ontario. Retrieved 05/30/2017 from http://www.fin.gov.on.ca/en/economy/demographics/projections/projections2015-2041.pdf
^2. Public Health Ontario. Snapshots: Ontario: Percentage of Adults 65+ Who Report Exceeding the LRADG by Age:
Age-specific Rate, Ontario, 2013-2014. Toronto, ON: Ontario Agency for Health Protection and Promotion [cited 06/26/17].  95% CI 22.4 – 24.9
^3. Public Health Ontario. Snapshots: Ontario: Percentage of Adults 65+ Who Report Heavy Drinking by Age:
Age-specific Rate, Ontario, 2013-2014. Toronto, ON: Ontario Agency for Health Protection and Promotion [cited 06/26/17].  ].  95% CI 4.6-5.7
^4.  Butt P, Beirness D,  Cesa F, Gliksman L, Paradis C & Stockwell T. (2011). Alcohol and health in Canada: A summary of evidence and guidelines for low risk drinking. Ottawa, ON: Canadian Centre on Substance Abuse.
^5. Educ’alcool (2006). Alcohol and health: Alcohol and seniors. Retrieved 05/25/2017 from http://educalcool.qc.ca/wp-content/uploads/2011/12/Alcohol_and_health_3.pdf
^6. Public Health Agency of Canada. (2014). Seniors’ falls in Canada: Second report. Ottawa, ON: Public Health Agency of Canada.
^7.  Center for Substance Abuse Treatment. Substance abuse among older adults. Rockville MD: Substance Abuse and Mental Health Services Administration (US); 1998. Retrieved 05/25/17 from https://www.ncbi.nih.gov/books/NBK64422/?report=printable.
^8. SAMHSA – Get connected: Linking older adults with resources on medication, alcohol, and mental health. HHS Pub. No. (SMA) 03-3824. Rockville, MD: Centre for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration, 2017. Retrieved 05/25/17 from https://store.samhsa.gov/shin/content/SMA03-3824/SMA03-3824.pdf

Submitted by:
Sheena Albanese, Health Promotion Planner
Thunder Bay District Health Unit