We need to talk about aging, alcohol, and addictive prescription drugs

Older adults tend to underreport their alcohol consumption, which poses a challenge for health professionals. Insufficient knowledge makes it less likely for them to identify risky or harmful alcohol use among older adults, compared to younger people.

A complex picture

Several reasons contribute to this. Some older adults tend not to discuss alcohol consumption or drug misuse due to a perception of stigma or shame. Another important factor is that many might not realize that alcohol and addictive prescription drugs affect people differently with age. It can also be difficult to distinguish symptoms of risky or harmful alcohol use or addictive prescription drugs from symptoms of aging and disease.

Many older adults are unaware that they are at risk. Healthcare professionals who meet with the elderly, in various services, are in a unique position to share their knowledge about aging, alcohol, and addictive prescription drugs. This is, however, perceived as a difficult issue.

Older adults today drink more alcohol compared to previous generations

The size of the older adult population is increasing rapidly. In recent decades, alcohol consumption among this segment of the population has also increased across Scandinavia. It is not uncommon for older adults to carry their drinking habits from younger years with them. Alcohol has its positive and negative sides, even for older adults. Research shows that alcohol is often associated with social engagement and enjoyment of life in older adults. For others, alcohol becomes a comfort in hard times and difficult everyday life. Research also indicates an increase in risky alcohol use among older adults in the last 20 years. This trend has occurred simultaneously with an increase in the intake of addictive prescription drugs among older adults. Combining alcohol and addictive prescription drugs can be very harmful and, in the worst case, lead to fatal overdoses.

Knowledge gaps

Older adults do not necessarily know about the steady decline in body functions as we age. As we get older, our metabolism slows down, and both the proportion of fluid in the body and body mass decrease. The body’s ability to absorb, distribute, and break down alcohol weakens. Even small amounts of alcohol can have negative consequences for older adults’ health. Therefore, increased consumption of alcohol among older adults increases the risk of alcohol-related deaths, illnesses, injuries, accidents, as well as drug interaction effects. Increased alcohol consumption can also limit the quality of life for older adults and their opportunities to manage the activities of everyday life. According to research, older adults often do not recognize, or they have a lack of knowledge about these risks, making it harder to make informed decisions about health consequences.

Lack of knowledge also exists among health professionals

It is important to draw attention to how we can detect and help older adults at risk at an early stage, and preferably before risky or harmful alcohol use or addictive prescription drugs occur. To do so, we must dare to ask and talk about the topic with the person concerned.

The purpose of talking to older adults about alcohol and addictive prescription drugs is not necessarily to uncover risky or harmful use, but to help the older adult understand the connection between aging and vulnerability to negative health consequences due to alcohol and addictive prescription drug use. However, experience from the field of practice shows that a significant proportion of health professionals find it difficult to talk to and ask older adults about their alcohol habits.

There can be many different reasons for this, and attitudes can be one of them. If health professionals themselves think alcohol and drugs are private matters, then it is less likely that they will raise the topic. If health professionals do not believe that older people can make changes, this can also be a barrier to asking the right questions.

Another important factor is a lack of knowledge. It is not uncommon for health professionals to feel that they do not have sufficient routines in place or enough knowledge when it comes to this subject. The stated lack of knowledge is worrying and should be taken seriously. Knowledge is a prerequisite for providing good and age-appropriate follow-up to older people with risky or harmful alcohol use.

Implications for practice

Not all older adults want to make changes. The elderly have the same right as others to decide on their own lives, and their experiences and wishes must be respected. Despite this, it is important that older adults have the information and knowledge necessary to become aware of risky use, to contact the health service in case of concern, and to make decisions related to their health. A lack of knowledge limits the opportunity for the elderly to seek help and to participate in the follow-ups available to them. A mutual exchange of knowledge between the elderly and health professionals is important both to promote user participation and to best adapt the approach and follow-up.

As it can be difficult to distinguish the symptoms of risky or harmful alcohol use from symptoms of aging and disease, it might be challenging for health professionals to know who is at risk and who is not, and thus whom to raise the topic with. One solution is to make it a routine to raise the topic, for example, when an older adult is prescribed addictive drugs that should not be combined with alcohol, is admitted to the hospital after a fall, or as part of a conversation that includes preventive and health-promoting measures.

Different resources in different parts of Norway

Enhancing competency within the healthcare sector is of great importance. Resources, in the form of services available and knowledge, vary significantly across Norway. It is important to ensure that the measures initiated are adapted and made available to all municipalities, including rural areas, where access to resources is limited.

KORUS (The Competence Centre on Alcohol and Drugs) has created an e-learning program about the topics of aging, alcohol, and addictive prescription drugs. The program offers basic knowledge about these topics available to everyone across Norway when it suits the individual. KORUS also offers knowledge and expertise on the subject of aging, alcohol, and addictive drugs that have been adapted to the needs of the individual service. You can read more about this here. 

The distribution of responsibilities should also be clarified. Just as important as knowledge within the various services are the framework and the understanding of one’s role when it comes to uncovering, intervening, and acting on the basis of concern. It is not sufficient to have the necessary knowledge if one does not have room to act or consider it as one’s responsibility to do something. When boundaries between different people or services and the areas of responsibilities are unclear, this in itself can be a barrier to discovering, talking to older adults, and getting a grip on their risky or harmful use of alcohol.

The article is written by:

June Rondestvedt, The Competence Centre on Alcohol and Drugs – region North.

on the request of PopNAD