Alcohol Complicates Multimorbidity in Older Adults
Authors Duncan Stewart, senior lecturer in addictive behaviours and public health, and Jim McCambridge, professor of addictive behaviours and public health, write about complications to multi-morbidity due to alcohol in the editorial.
They state attention to alcohol should be integral to routine care. Accordingly, there are more people living with multi-morbidity as they age. Trends in alcohol consumption show higher levels of alcohol use among older birth cohorts in high income countries, and older people in the UK consume more alcohol than those in other European countries, Australasia, and North America. Alcohol, even at low doses, increase challenges of clinical management of older adults with multi-morbidity.
The authors discuss health risks of alcohol use on older adults. Accordingly, alcohol is a particular concern among older people because metabolic efficiency is diminished with age. Following are several adverse health effects for older people from alcohol:
- Alcohol can make existing health problems worse by posing direct risks of organ damage.
- Alcohol compromises treatment effectiveness and the safety of prescription drugs.
- Changes to the absorption, distribution, and metabolism of alcohol in older age groups makes interactions with medications more likely.
- Alcohol can also have a direct and adverse effect on many conditions for which medications are prescribed.
The authors cite higher alcohol related hospital admissions and mortality among people aged over 65 than in younger people as evidence for the increasing problem of alcohol use among older people. In more deprived communities multi-morbidity is most prevalent and alcohol’s health damage greatest.
Alcohol complicates health inequalities across the lifecourse.
The authors state that the NHS, like other health systems, is poorly designed to meet the challenges of an ageing population. There are major gaps in research evidence which the clinicians must contend with and there is a lack of guidance on how alcohol consumption should be managed in relation to potential effects on multi-morbidity.
Progress requires that alcohol consumption becomes integral to societal and health system responses to multi-morbidity, particularly in countries like the UK where alcohol is culturally embedded but not prominent in debates about health service reform. The NHS long term plan provides an example of a missed opportunity to reconsider what preventing alcohol related harm means in the context of an ageing population characterised by multi-morbidity.
The authors end with:
First, however, we need new thinking about prevention.”