Judith Davey
What do we know about alcohol drinking among older New Zealanders?
Very little, according to the Health Promotion Association (HPA).[1]
The 2012/13 New Zealand Health Survey showed that around 82% of 55 to 64-year-olds, 79% of 65 to 74-year olds and 66% of people 75+ drink alcohol.[2] The highest rates are for Europeans/Pākehā – 77%, followed by 58% of Māori, 21% of Pacific peoples and 52% of ‘other’ ethnic groups.[3]
Wine is the most popular tipple among older people, followed a distant second by beer and spirits. Port or sherry drinking is now comparatively rare. When asked, older people say they drink to be social, to enhance social situations or special occasions, or to relax or unwind. Most link alcohol with food, many drinking around meal times. Older people mainly drink at home or when visiting friends or family. As they move into their sixties and seventies, older people tend to drink less alcohol than before. For some, especially older men, their drinking evolves into a pattern of daily, or near daily alcohol use, but at relatively low levels of consumption per drinking occasion – ‘a little but often’.
What are the reasons for these changes?
They may include reduced social activity, lower incomes, the onset of health problems, or a combination of factors. Alcohol aggravates health conditions such as liver problems, high blood pressure, diabetes and depression. People with these conditions may be advised by their doctor to reduce their drinking.
Health problems may disrupt usual patterns of socialising, making it harder to go out or limiting energy. Some older people also tone down their drinking in response to physiological changes that increase their sensitivity to alcohol’s effects. Of course some maintain or even increase their alcohol consumption as they age. They may have more opportunities to socialise and fewer family and work responsibilities.
What are the effects of drinking for older people?
While many continue to drink in old age, some older people drink in ways that are potentially unsafe. Apart from obvious effects such as intoxication, alcohol dependence or abuse, a wide range of health conditions have been linked to drinking, including liver disease, pancreatitis, cancer, stroke and high blood pressure. Some of these may result from the cumulative effects of a lifetime of alcohol use.
Also, many older people take medicines that are incompatible with alcohol, such as antihistamines, sedatives and antidepressants. Drinking alcohol may exaggerate the effects of drugs, increasing the risk of injury from falls or other mishaps.
Alcohol itself may be the cause of accidents suffered by older people, which often occur at home. Falls are a particular risk and may have long-term consequences.
Because of decreased tolerance, older people show certain effects of alcohol at lower doses than younger people. This is why older people can have the same drinking pattern for many years and only have alcohol problems when they are older.
On the other hand, a number of studies identify associations between low alcohol use and reduced risks for a few health conditions, such as coronary artery disease. Do the negative effects of alcohol outweigh the positive effects? The experts are still not sure.
How many older people drink hazardously or harmfully?
The majority of older men and women drink safely. The Health Survey found that only 11% of 55 to 64-year-old drinkers, 7% of 65 to 74-year-old drinkers and 3% of 75+ year-olds drinkers drank hazardously or harmfully. But, given older people’s greater vulnerability to the physical effects of alcohol, their greater risk of chronic medical conditions and use of medicines incompatible with alcohol, perhaps hazardous drinking thresholds should be lower for older people.
Categories of older problem drinkers
‘Early-onset’ problem drinkers are those who have been drinking harmfully for much of their adult lives, and continue to do so.
‘Late-onset’ problem drinkers may have used alcohol at mild or moderate levels when younger, but, as they age they may start to drink much more heavily, for reasons often associated with grief and loss, anxiety, depression, boredom, isolation, loneliness and chronic pain. Sometimes they are advised to have a “nightcap” to help with sleeping difficulties, which can lead on to dependency.
Future challenges
Would it be useful to stipulate age-specific safe drinking guidelines for older people? How can we identify and help older people who may be drinking hazardously or harmfully? And how can we help people cope with bereavement, retirement, loss of independence and physical and cognitive impairments?
Alcohol abuse and dependency may remain undetected in older people because many are socially isolated. They are less likely to get in trouble with the law and less likely to be noticeably drunk in public. Older people with alcohol problems are often wary of accessing treatment because of associated stigma and shame. It is important that these people have regular social contact, and receive non-judgemental and unconditional treatment.
[1] Ian Hodges and Caroline Maskill (October 2014) Alcohol and Older Adults in New Zealand. Health Promotion Agency, Wellington.
[2] New Zealand Health Survey 2012-2013, Ministry of Health, Wellington.
[3] Percentage of people 64 plus who had consumed alcohol in the previous 12 months.
On Research 