Wrong alcohol trend among older Swedes
Addiction doctors and researchers in Sweden state that alcohol is a serious risk factor for morbidity and mortality both in Sweden and globally.
They raise the alarm that rising alcohol use among older Swedes is masked by the positive reduction in overall alcohol use in the country. Population-level alcohol consumption has declined in Sweden from 10.6 liters of alcohol in 2004 to 8.7 liters in 2021.
This positive development has largely been driven by young adults. It means that mortality caused by alcohol is also falling in the entire population.
On the other hand, people over the age of 65 have increased their alcohol intake and with it mortality caused by alcohol is rising among the elderly.
The addiction doctors and researchers criticize that surveys from the National Board of Health and Welfare to Swedish municipalities reveal that very few patients receive help for their alcohol use problems.
Only 1% are offered support services for alcohol use disorder.
There has been no improvement in the provision of much needed mental health services for alcohol use problems in the period of 2013 to 2021.
Older people are more vulnerable to alcohol harm
In 2019, Movendi International member organization IOGT-NTO, in collaboration with addiction researchers and, among others, the Swedish Medical Association produced the report Alcohol and the Elderly.
Already then, the report revealed evidence that alcohol consumption and alcohol harm were increasing among older people in Sweden.
According to the report, increased sensitivity to alcohol in old age combined with the ageing process can increase risk of disease and accidents among older people caused by alcohol.
For example, use of alcohol increases risk of cardiovascular disease, diabetes, dementia, and cancer for older people. The harm is aggravated when alcohol is combined with prescription drugs. For example this combination can result in heightened risk of falls and injuries. The report also outlines various health and social challenges older people may face as a result of alcohol use. These challenges include, depression, suicide, road traffic accidents but also intimate violence and more broadly elder abuse.
Several common medical conditions are caused, or worsened, by high alcohol consumption, the doctors write in Sweden’s Medical Journal “Läkartidningen“:
- cardiovascular diseases,
- several forms of cancer,
- sleep disorders,
- neurological problems,
- stomach and skin problems,
- infections and difficult-to-heal wounds.
According to the World Health Organization, there is a connection between alcohol and over 200 diseases. Alcohol also interacts with other drugs, and questions about patients’ alcohol consumption are therefore important when prescribing drugs.”Per Nilsen, Sven Andréasson, and Karin Hyland, in Läkartidningen
Minimizing alcohol harm for older people
Alcohol consumption and alcohol-related harm, whether in the form of chronic disease or acute harm, has increased amongst Sweden’s older people in recent years. The percentage of the population classified as elderly has increased and will continue to do so.
Prevention of disease and harm, including disease and harm due to alcohol, is, therefore, very important – both for all those at risk and for the health and medical care sector. The report provides a set of recommendations to prevent and reduce alcohol harm specific to older people:
- While there is no safe limit for alcohol use, older persons who are using alcohol are advised to limit their use to 1 or less alcoholic drinks per day to reduce health risks.
- Those who don’t consume alcohol or who use alcohol occasionally are advised to not begin alcohol use, re-initiate alcohol use, and not to consume alcohol more frequently on the basis of health considerations.
- Older people suffering from health conditions including liver disease, peptic ulcer disease, cardiac arrhythmia, are driving, have cognitive difficulties, a history of falls or poor balance, or who take psychoactive or sedating medications are advised not to consume any amount of alcohol to mitigate further harm from alcohol in combination with these conditions.
Alcohol prevention in primary care – need for a new agenda
In screening vists, the doctor has the opportunity to tell the patient how various health problems can be affected by alcohol. This opens the chance to have conversations about alcohol consumption and possible problems.
Such conversations are important and are a matter of collaboration between patient and doctor. The doctor’s role is to help the patient find motivation to change and to talk about an achievable goal together, for example to lower alcohol use in line with low-risk alcohol guidelines. Follow-up is of great importance.”Per Nilsen, Sven Andréasson, and Karin Hyland, in Läkartidningen
In Sweden, the risk of missing patients with alcohol use problems is high. In a study that compared general and pragmatic screening, 70% of patients with higher risk alcohol use patterns were identified with general screening, while pragmatic screening only identified 38%. Pragmatic screening is widely used, while general screening is hardly used at all.
Research is important to improve the alcohol preventive work in primary health care. Therefore a new research agenda is needed with more research on pragmatic screening.
In addition, healthcare staff need further training on clinical conditions that can be linked to alcohol, and that courses on alcohol-related symptoms need to be carried out and evaluated.
Not just Sweden – alcohol a growing problem among older people in many countries
It is not “just” Sweden where society faces a growing alcohol burden among older people. This is a rising problem among many high-income countries with ageing population. Countries such as the United Kingdom, China, Australia, and Italy. Another example is Germany.
Movendi International is covering the rising alcohol problem regularly and has reported more than 20 times.
As in Sweden, also in Germany, alcohol harm among older people is on the rise.
Over a decade from 2007 to 2017 the number of older people between 65 to 84 years treated for acute alcohol intoxication increased by two thirds.
The Kaufmännische Krankenkasse (KKH, a health insurer) reports more than 355,500 older people over 65 years suffer from alcohol harm. The increase in acute alcohol intoxication was even higher for men. Among the 70 to 74-year-olds, it was around 95% and among the 80- to 84-year-olds more than double.