When I started my consultant job specialising in older people’s mental health, I did not have the faintest idea that I would be writing this nearly 20 years later against the backdrop of an alarming rise in the physical, psychological and social harms from alcohol among older people.

5 years into my job, I could bear in no longer. With a ward where up to half my older patients had alcohol related mental health problems and finding that my community team was giving the stock answer of “Sorry, but we are not an addictions service” for anyone referred where alcohol played a large part in the presenting problem, I decided to gain additional expertise in addictions. It wasn’t easy juggling this against a busy clinical job, but it meant that my eyes were finally opened to the possibility of developing a service for older people whose alcohol misuse accompanied other mental disorders such as depression, anxiety and dementia.

Sadly, it meant pushing against a door that was not just closed, but locked. To be told that a senior colleague had said “he is not an alcohol doctor” and others who did not consider it to be enough of a problem in their service, offered cold comfort to what could easily have been a beleaguered will. Was this only a problem for an inner-city area where a culture of heavy drinking and a plentiful supply of off-licenses mixed with high deprivation and sprawling housing estates? Luckily for me, there were strong allies in open-minded colleagues who helped me to start thinking about where to begin in addressing the problems that were swept away far from view. The alcohol related fall that presented to the Emergency Department and then sent home. The referral for assessment of someone threatened with eviction because they spent the whole day drinking and was keeping neighbours awake at night. Even the person already under the care of our service who had never even been asked about their drinking. All went under the clinical radar.

It was not until 5 years ago, that I was fortunate enough to link up with a colleague in the field of addictions. Together, we have produced a report highlighting the growing harm from drinking in older people, followed by an information guide to help health and social care professionals with assessment and treatment of common problems accompanying alcohol misuse.

But I did not stop there. That wasn’t enough to be able to show the scale of the shape of things to come. 3 years ago, I put together a website to provide information about alcohol and older people, with a rigorous analysis of updates to national data on drinking in older people. It doesn’t make easy reading, I can tell you. It’s not the graphs themselves, it’s the differences in harm between younger and older people’s drinking that are now worlds apart.

In Scotland, between 2007/08 and 2013/14, there was a 10% drop in the number of admissions that were wholly attributable to alcohol in the 25-54 age group. This stands in contrast to the 2% increase in the number of admissions for the same reason in people aged 55 and above. In fact, both age groups had risen by about the same rate until the late 2000s, but it was numbers in the younger (not the older) age groups that started to drop off after this time. 

So what about England? Surely there wasn’t going to be much of a difference? After all, the headlines are hardly rife with stories of older people being drunk and disorderly on a Saturday night. Well, the figures tell a very different story.

In the younger age group over the same time frame, the number of hospital admissions in England that are wholly attributable to alcohol have increased by 30%. For those aged 55 and above, it is a whopping 70%. This is also way out of proportion to the actual increase in the number of older people over this time.

But that’s not the end of the story. Over the 17 years from 1997/8 to 2014/15, the number of alcohol related deaths in the United Kingdom has risen by 27% in the 25-54 age group, but by 63% in the 55 and over group.

The health and social costs of alcohol to lives and livelihoods among older people are considerable. As I have seen from my own clinical service, the figures above are only the tip of a very large iceberg. Whether through longer term drinking that may result in a wide range of physical problems or frequent heavy drinking associated with more acute problems such as falls and head injury, our collective responsibility for how much we drink cannot be overstated.

Until the media brought back the term to life, I had never heard of the term ‘baby boomers’, but it is clear that the post war group of older people with very different views about alcohol than today’s younger age groups, need a brighter light shone on the scale of the problem.

With increasingly greater affordability of alcohol, access to cheap strong alcohol cannot be ignored. Scotland is set to enforce a minimum unit price for alcohol, which has been shown to reduce harm from alcohol in other countries.  The more recent introduction of ‘low risk’ guidelines of 14 units for men and women is so worded to emphasise the fact that alcohol is a harmful drug with no safe limit for everyone. Time will tell as to whether this will make a difference to how we scrutinise our drinking habits.

Baby boomers will all be 55 and over in a few years and the cost to themselves and society in England shows no sign of abating. We need to provide better information, better services and better integration between all  heath, social care and voluntary providers if we want our Baby Boomers to benefit from adding life to years. So let’s make Alcohol Awareness 2016 one to remember for older people. It’s still not too late to make a difference.

Dr Tony Rao