Alcohol consumption, life course transitions and health in later life

Lead Research Organisation: Keele University
Department Name: Faculty of Humanities & Social Sciences

Abstract

Relatively little is known about the patterns of drinking in later life, the risk factors associated with excessive drinking at older ages and the relationship between drinking and other health conditions. To date most research on the risk factors of excessive drinking have focussed on younger ages, in part because of the distinctive age profile of drinking but also due to the predominance of life course approaches to health in which risks are accumulated over time. Yet notwithstanding these observations, there is growing awareness among health professionals that drinking at older ages is becoming more of an issue. This has been brought about due to the fact that the UK population is ageing, but also because recent population data on consumption suggest that while levels of consumption are declining among younger generations they are increasing at older ages. Thus excessive drinking in later life is becoming a more discernible public health issue, as more older people are reporting drinking in excess of the recommended weekly amount. Hence the relationship between drinking in later life and health and well-being cannot be ignored. Responsible drinking is associated with some health benefits and these tend to be more significant at older ages. However, drinking can also exacerbate health conditions that are more prominent in later life; such as high blood pressure, diabetes and ulcers as well as increasing the risk of liver disease. One particular cause for concern is the possible interaction between drinking and medication with the average person aged 65 and over taking two prescribed medicines a day and therefore the potential for interactions between medication and alcohol needs to be considered. However, we might expect that the health conditions that develop at older ages might also be associated with a decline in drinking, hence the causality between health and alcohol consumption will be complex and dynamic.

It is not only changes to health status that may bring about shifts in drinking behaviour, other transitions associated with housing, employment, family and partnerships may bring about either an increase or decline in alcohol consumption. This study with explore the stability of drinking at later life and the key events that are associated with changes in drinking patterns.

The research will be based on analysis of the English Longitudinal Study of Ageing. This study, which began in 2002 collects data on the health, economic position and quality of life of people aged over 50 and their partners. To date 6 waves are available for analysis. Data on alcohol consumption is available in all waves, though the questions used have changed over time. Cross-sectional analysis of this data will establish the main patterns of drinking in later life and the risk factors associated with binge drinking (excessive drinking on one particular day) and drinking in excess of the recommended weekly limits. The life history data will be used to identify past events and transitions that may be associated with later changes in drinking behaviour. The ELSA dataset contains detailed data on health status and this will be used to explore the relationship between alcohol consumption and health status. This analysis will investigate the dynamics of the relationship between changes in alcohol consumption and health conditions and how these are associated with life course transitions as well as past experiences.

The research will collaborate with users at all stages of analysis and dissemination and will explore the possibility of a practice-informed modelling approach to the analysis of health behaviours using longitudinal data.

The analysis will therefore extend knowledge about the dynamics and heterogeneity of drinking patterns at older ages.

Planned Impact

Health intervention policies to reduce harm from alcohol consumption have historically focused on younger ages in both the UK and other modern industrialised societies, although there is now growing concern about drinking at older ages. This issue has also been highlighted in the Parliamentary Select Committee for Science and Technology's report on alcohol guidelines. Users of this research will therefore include agencies promoting safe alcohol consumption, practitioners involved in delivering health and social care for older ages, and policy makers involved in the promotion and dissemination of harm-reduction strategies associated with drinking. The findings will also be relevant for the end-users as the analysis will draw attention to the dynamics of drinking and health at older ages. Lay interpretations of drinking at older ages often emphasise the ideal that 'no harm' can be done at older ages, but this research will set this observation into context, by discussing the potential risk factors and the trigger factors that might bring about a change in drinking practices at older ages.

To date, discussions around policy intervention which targets drinking behaviour at older ages have focussed on the desirability of age-specific recommended limits for alcohol intake. The general consensus among academic researchers and practitioners is that any recommendation away from a generic form will confuse people and necessitate arbitrary distinctions based on individual characteristics, such as age which are unlikely to be met with public endorsement. This research will not seek to make recommendations of the desirability of new limits, but will take a different approach through considering the dynamics and heterogeneity of drinking patterns. The team will work collaboratively with users to inform both practitioners working with older age groups as well as agencies involved in promoting health and well-being at old age and/or harm associated with alcohol about the socio-economic characteristics associated with harmful drinking, as well as the life course events that may bring about changes in drinking behaviour. The research will therefore enable agencies to target older people most at risk of suffering harm through alcohol consumption. The agencies involved here are potentially numerous, for example the Fire and Rescue Service has a particular interest in drinking in later life as this is a recognised safety risk in the home. Invitations to a wide, but selective group will be sent out to attend the workshops, which will be themed around i) identifying key issues surrounding drinking in later life; ii) discussion of interim findings; and, iii) implications for practice and policy recommendations. A fourth findings workshop will be organised in London to review the research with national agencies.

The project will adopt a practice-informed approach to analysis. Variables which will be included in the modelling process will be identified through a combination of dialogue with practitioners and older people and statistical and theoretical criteria. This dialogue will be facilitated by the workshops and the website blog (see below). An objective of the project is to promote the use of secondary data in health research and to highlight both the drawbacks and advantages of this empirical approach.

Dissemination to user groups will necessitate the preparation of clear and succinct briefings. A balance will need to be maintained between clear and accessible dissemination strategies to ensure that the findings are not reduced to caricatures of drinking at older ages. Dissemination will include face to face and virtual activities and where possible will emphasise interactive engagement. In addition to a user seminar and policy briefings, virtual material will be made available via a project website and will include a podcast of the main findings and a forum for dialogue between users and the project team.
 
Description This project revealed new findings about the relationship between alcohol consumption, life course events associated with partnership status and health, and individual resources in later life. The analysis used the English Longitudinal Study of Ageing which provided data on alcohol consumption and life events over a ten year period (approximately 2000-2010) for a sample of 2046 men and 2692 women aged 45 and over. We considered how both the quantity and frequency of drinking varied for different groups of older people at the beginning of the period of observation and changes in drinking behaviour other time.

The findings confirmed that older men tend to drink more and to drink more often than women. For both men and women, those in the highest income group and with highest level of education drank more and drank more frequently. Of particular interest was the relationship between partnership status and drinking. Men who were not in a partnership drank more compared to men with a partner at the baseline, though there was no difference in the frequency of men's drinking by partnership status. For women being in a partnership did not influence drinking behaviours at the baseline, though over the ten year period loss of a partner was associated with a faster decline in weekly alcohol consumption and with drinking less often. This demonstrates that being in a partnership moderates how much older men drink but this was not found for women's consumption. This new finding reveals the importance of understanding the social context of drinking. This finding could be explored further using individual case histories.

The analysis also considered the relationship between drinking and health. There is considerable medical and popular interest in the possibility that moderate alcohol consumption may be associated with better health in later life, while not drinking and heavy consumption are associated with worse health. Using the longitudinal data we explored the association between changes in drinking and health. The analysis found that over time older people with poor health and deteriorating health reported a steeper decline in the quantity and frequency of alcohol consumed. This finding supports the assumption that older people moderate their drinking in response to health events, in other words health status influences how much older people drink. We suggest that the observation that drinking in later life is associated with better health does not necessarily support the assumption that drinking is good for you, but that consumption is dependent on health status. Understanding how health moderates drinking in later life is an important area for further research which could consider the importance of medical advice about drinking, taking medications and whether deteriorating health limits the social opportunities for drinking.

One additional finding relating to health and drinking is that older people who stopped drinking at the start of the period of observation and remained in the study were more likely to experience an improvement in health compared to drinkers. This suggests that while older people might reduce consumption in response to declining health, for some this reduction may lead to an improvement in health conditions.
Exploitation Route The findings will be of interest to public health practitioners providing alcohol support services for older people and we have already been contacted by one local authority (Dorset County Council). The findings confirm that while the majority of older people drink moderately, or not at all, there are some groups that do drink more. Our findings suggest that the group most at risk of heavy drinking in later life are older men, not in a partnership with high levels of education and above average wealth. Targeting this group is not necessarily straight forward as these men might not necessarily identify their drinking as a problem behaviour. Moreover this group are more likely to experience good health hence the need for any immediate intervention might not be apparent. Our findings also challenge the assumption that the end of a partnership is associated with alcohol misuse in later life, which has been found in qualitative studies. In particular our analysis of drinking behaviours demonstrates that change in partnership status for women is associated with a reduction in consumption. Hence it is not necessarily appropriate to target alcohol services at this group of older people.
Sectors Agriculture, Food and Drink,Communities and Social Services/Policy,Healthcare
URL http://www.keele.ac.uk/drinkinglaterlife/
 
Description This project was funded as part of the ESRC's Secondary Data Analysis Initiative. The research involved analysis of the English Longitudinal Study of Ageing (ELSA) to address the following aims: 1. To extend understanding of the diversity of patterns of alcohol consumption at older ages distinguishing between drinkers and non-drinkers, and among the latter those who binge drink and/or exceed weekly recommended amounts. 2. To identify the socio-demographic dynamics of drinking during later life and the life events that are associated with changes in drinking behaviours, including transitions in housing, employment, family life and relationships. 3. To explore the relationship between drinking and health conditions in later life 4. To establish the importance of secondary survey data, specifically the English Longitudinal Study of Ageing (ELSA), in supporting policy initiatives directed towards individual health behaviours 5. To inform health policy initiatives on drinking in later life through identifying the risks associated with excessive drinking (defined as either binge drinking or drinking more than recommended weekly amounts) and the relationship between alcohol consumption, health and well-being in later life. The analysis aims were met in full and the research findings confirm the significance of indicators of well-being for older people's alcohol consumption. In particular rather than identifying specific harms associated with drinking in later life, we show that drinking can be considered an indicator of well-being, and it is older adults with better health and more resources (but also those who smoke) who drink most and who drink more often in later life. The impact from the research has been directed towards enhancing quality of life, health and creative output. Working with a range of stakeholders we can demonstrate both instrumental impact, though working with the charity Drinkaware on their current campaign to target harmful drinking among men aged 45-65, and conceptual impact, particularly contributing to public understanding of the issues associated with drinking in later life through coverage of the research findings in national media and presentations to non-academic audiences. The relevant stakeholders for the project include members of the public, the drinks industry and practitioners working with both older people and alcohol issues and we have worked with these stakeholders as follows: Members of the Public: Extending Understanding of the Issues Associated with Drinking in Later Life: Members of the public have been involved at all stages of the research, from design, analysis through to dissemination. Working with the advocacy agency, the Beth Johnson Foundation, we established a lay expert group recruiting older adults from Stoke on Trent. This group met twice. The first workshop was held on 17th April 2013 at the Beth Johnson Foundation and 11 members of the public and Beth Johnson staff attended this workshop. This workshop was used to identify the issues that participants associated with drinking in later life to inform subsequent analysis. The second workshop was held on 16th May 2014 to discuss the findings of the research, again with 11 members in attendance. This workshop was designed to enhance interpretation of the research findings. An end of project dissemination event was organised in collaboration with Age UK in London on 19th September 2014 and two of the lay expert group were able to attend this event. This event was open to academics, members of the public and key practitioners and in total 37 people registered to attend the event. Participants included members of the public, academic researchers, staff from Age UK, representatives from the drinks industry, local government employees working on alcohol and drug misuse teams, and representatives from the charity sector including Alcohol Concern. Following this event a press release was prepared by the PI in collaboration with McCann Public Relations (consultants for Keele University media and external relations). The press release was issued in December 2014 following the submission of the grant summary report to ESRC. The research findings were reported extensively in national, local and overseas media on 24th December 2014 and on following days including: • The Times: Lead front page article titled 'Big Fall in Middle Age Drinking' - online and print editions (Clare Holdsworth was interviewed by Chris Smyth, Health Correspondent for The Times on 23rd December). • The Daily Mail: Online and print editions • The Guardian: Online and print editions • The Daily Telegraph: Online and print editions • City AM: Online • The Northern Echo: Online • The Times, Ireland: Online and print editions • The Times, Scotland: Online and print editions • Yahoo: Online • Chicago Chronicle: Online • Harrogate Advertiser: Online • Birmingham Mail: Print • Bioscholar: Online • The Healthsite: Online • The Sunday Times: Print (Matt Rudd Column 28th December) • Z News (India): Online • Trends Urology and Men's Health: Online • Worcester News: Print • Health Canal: Online • NewsMedical: Online • Medical Press: Online • Panorama AM: Online (Armenia) The research was also distributed to other titles through the Press Association and Clare Holdsworth was interviewed on LBC Radio on 24th December. Cartoon from The Daily Mail 24th December 2014 (Unfortunately the research fish website cannot display the cartoon). The research findings were also presented at the British Science Festival at Bradford University on 7th September 2015. Clare Holdsworth has also been invited to talk at the Knutsford SciBar in January 2016, a regional British Science Association group. A blog has also been written to support a recent publication in BMC Public Health http://blogs.biomedcentral.com/bmcseriesblog/2015/09/17/alcohol-consumption-predict-future-health-among-older-adults/ The Drinks Industry: Drinkaware Campaign Targeting Male Drinkers aged 45-65: The drinks industry was not identified as stakeholder group in the grant application, though has emerged as one of the most important stakeholders. In June 2015 Clare Holdsworth was approached by Dr John Larsen, Director of Evidence and Impact at the charity Drinkaware to contribute to a forthcoming campaign targeting male drinkers aged 45 to 65. Drinkaware is an independent charity, supported by voluntary donations from the drinks industry and major UK supermarkets to reduce alcohol misuse and harm in the UK. The charity provides people with evidence-based information about alcohol and has identified male drinkers in the age group 45-65 as a key target group. It is proposing to launch a campaign to target older male drinkers in Autumn 2015 and since May 2015 has been gathering evidence and commissioning research on older male drinkers. Clare Holdsworth has been in correspondence with Dr Larsen since May 2015 and in June 2015 was interviewed by Simon Christmas, who is carrying out research for Drinkaware to inform the campaign. Drinkaware has been provided with full details of the research findings in response to the call for evidence and Clare Holdsworth presented the research findings at a workshop on 5th August 2015, attended by Drinkaware staff, representatives from Drinkaware PR and advertising agencies as well as other academics. For this workshop the ELSA analysis was restricted to the age group 45-65 to match the Drinkaware target group. The findings from the analysis have been used in framing the Drinkaware qualitative research with adults aged 45 to 65, in particular the finding that the relationship between partnership and alcohol consumption differs for men and women was used to stimulate discussions about reasons why some older men drink more. Researchers at Drinkaware are in the process of completing a systematic review of evidence on the impacts of older men's drinking and Clare Holdsworth has agreed to comment on this review. At the time of writing the details of the Drinkaware campaign have not been finalised but we continue to be in regular correspondence and will work with Drinkaware as the campaign is finalised. Local Authority Employees: Alcohol and Drug Misuse Harm Prevention: There has been some interest in the findings form local authority alcohol and drug misuse teams. In particular we have rerun analysis for Dorset County Council, following the dissemination meeting on 19th September 2014, to identify characteristics of older people who misuse alcohol. Challenges in targeting impact: Though there has been considerable public interest in the research, we have found it harder to identify public health practitioners as key stakeholders. Results of the study were requested by the Health Improvement Analytical Team (HIAT), at the Department of Health. One challenge is then determining where these results later go on to inform policy. Another challenge is that the research findings clearly demonstrate that alcohol consumption is associated with well-being in later life. As discussed with representatives from Age UK at the 19th September workshop, older wealthy and well-educated men are unlikely to respond to interventions that target their health, in fact they are more likely to anticipate to volunteer with Age UK to support older adults with fewer resources, rather than recognise themselves as recipients of public interventions. The media coverage is extremely useful in this regard as it identifies wealthy older men as the group that drink the most (as the Daily Mail cartoon illustrates) and hopefully this coverage has gone some away to informing older adults about who drinks most in later life.
First Year Of Impact 2014
Sector Agriculture, Food and Drink,Communities and Social Services/Policy,Healthcare,Retail
Impact Types Societal
 
Description Citation in Drink wise, Age Well publication
Geographic Reach National 
Policy Influence Type Citation in other policy documents
URL http://www.ilcuk.org.uk/index.php/publications/publication_details/drink_wise_age_well_alcohol_use_a...
 
Description Contribution to Drinkaware campaign on middle age male drinkers
Geographic Reach National 
Policy Influence Type Participation in a guidance/advisory committee
 
Description Community workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Participants in your research and patient groups
Results and Impact We organised an event with the Beth Johnson Foundation in Stoke to talk about our research findings with older people in the community. At the event we presented the initial findings and talked about possible explanations, particularly relating to gender differences in drinking in later life. The presentation of the findings sparked a very lively and engaging discussion about drinking in later life

Our findings about drinking in later life differ from some populist interpretations, particularly with reference to gender and health. The participants at the workshop are all active in their own communities and support other older people, they found the results challenged some of assumptions about drinking in later life and talked about how the results made them think about how to to support other older people.
Year(s) Of Engagement Activity 2014
 
Description Conference invited presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact This was an invited presentation on Alcohol consumption, life course transitions and health in later life at the Alcohol Research UK Annual Confernce on the 16th March at the Library conference centre. Participants included other researchers, practitioners working with alcohol-related issues and representatives from local government, national government and third sector organisations working on alcohol issues.
Year(s) Of Engagement Activity 2016
URL http://alcoholresearchuk.org/news/alcohol-research-uk-annual-conference-2016/
 
Description Dissemination event for practitioners working with older people and/or alcohol issues 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The presentation generated considerable debate about drinking in later life and whether it is should be a priority concern for public health intervention

We have had follow up conversations with participants after the event. In particular Dorset County Council asked for further analysis of the incidence of heavy drinking in later life to inform their decision making about providing alcohol services for older people. We have also talked with Dorset County Council about follow up research with older people.
Year(s) Of Engagement Activity 2014
 
Description Drinking in later life, health and social transitions: findings from the ELSA study 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Health professionals
Results and Impact talk with good discussion afterwards

after my talk some PH professionals asked about how this research may be translated to local policies
Year(s) Of Engagement Activity 2014
 
Description Invited talk at conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Invited contribution to International Longevity Centre organised event on Drink Wise, Age Well Inquiry - Alcohol and Over 50s in Employment at the House of Lords, May 2016.
Year(s) Of Engagement Activity 2016
 
Description National media coverage 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact We released a press release in December 2014 when the project finished. This was picked up by national media and was on the front page of The Times on 24th December 2014 (lead article). The PI (Clare Holdsworth) was interviewed by Chris Smyth (Times journalist) for this article. It was also reported in;
• The Daily Mail: Online and print editions
• The Guardian: Online and print editions
• The Daily Telegraph: Online and print editions
• City AM: Online
• The Northern Echo: Online
• The Times, Ireland: Online and print editions
• The Times, Scotland: Online and print editions
• Yahoo: Online
• Chicago Chronicle: Online
• Harrogate Advertiser: Online
• Birmingham Mail: Print
• Bioscholar: Online
• The Healthsite: Online
• The Sunday Times: Print (Matt Rudd Column 28th December)
• Z News (India): Online
• Trends Urology and Men's Health: Online
• Worcester News: Print
• Health Canal: Online
• NewsMedical: Online
• Medical Press: Online
• Panorama AM: Online (Armenia)
The research was also distributed to other titles through the Press Association and Clare Holdsworth was interviewed on LBC Radio on 24th December.
Following this extensive media coverage results of the study were requested by the Health Improvement Analytical Team (HIAT), at the Department of Health.
Year(s) Of Engagement Activity 2014
 
Description Presentation at British Science Association Festival 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact The British Science Association Festival is a public event to showcase current scientific research. It is open to members of the public
Year(s) Of Engagement Activity 2015
 
Description Research planning workshop 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Participants in your research and patient groups
Results and Impact We used the workshop discussion to inform our modelling process

The impact of this workshop was mainly to improve our understanding of drinking in later life and inform our modelling. However our participants also talked afterwards about how much they had enjoyed the event, and for one participant in particular talking about her recent experiences following the death of her husband gave her the opportunity to talk about this for the first time.
Year(s) Of Engagement Activity 2013
 
Description Talk at Knutsford Scibar 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Knutsford Scibar is affiliated to the British Science Association. It organised monthly meetings and the audience is generally older people (50 and over) and takes places in a bar. It is therefore a very appropriate venue to talk about research findings on alcohol consumption in later life. There was a very lively discussion and participants were very interested in the finding that drinking is an indicator rather than a cause of good health. I had a number of email queries afterwards for further details on the research. Some participants wanted to talk about their own drinking experiences.
Year(s) Of Engagement Activity 2016