Alcohol use in retirement: A silent epidemic?

Posted by Roxanne Armstrong-Moore, Fuse PhD student, University of Sunderland

I was on a course recently and someone mentioned that her parents, since retiring were all about the “three Gs – Gardening, Grandchildren and the Grape”. Laughter ensued from other colleagues, then a sadness dawned on me – she explained that the drinking had gone beyond a social drink with friends and was ingrained in their lives, the glass of wine was getting earlier and earlier and functioning was getting less. It made me think, why is this acceptable once someone has left work? Of course, individuals have worked hard all their lives and they deserve some respite – but should this come at a cost of lessened functioning, higher chance of diseases, premature death and breakdowns in the relationships that have been nurtured over a lifetime?

My PhD aims to develop a strategy for those in, or about to enter retirement, to avoid what seems to be a downward spiral into ill health.

In what is a relatively scarce area of literature, myself and my supervisory team have begun this task by conducting a systematic review of current literature. This is to investigate what we currently know about current interventions and how they can help older individuals to reduce negative effects of alcohol. Six papers were included, all of which were in the United States. Individuals in this age group appear to respond well to interventions, with all interventions showing improvements (a reduction in drinking or, in one case study, improvements in quality of life) in at least one area of alcohol consumption or frequency of consumption. These findings were presented at the European Health Psychology Conference in Aberdeen (2016).

This scarce amount of literature available on interventions shows that older people are currently being neglected in our field. Healthcare professionals may feel it is not their duty to step in and “ruin the fun” but - with predictions that by 2050, 22% of the world population will be aged 60 and over, and that a significant amount of these older individuals will have a “pattern or level of drinking which places them at harm” (Wadd & Galvani, 2014, p. 656)1 - something needs to be done.

But what can be done? Don’t they deserve to have a drink? Are we spoiling their fun? Would they even want an intervention and how would this work? This is where the hard work begins…

Older people are more susceptible to the detrimental effects of alcohol, as tolerance to alcohol lowers with age. Drinking more than five standard drinks per week has been found to quadruple the risk of developing psychiatric problems including depression and memory loss (Stevenson, 2005)2. Cognitive impairment as a result of alcohol use can lead to an increased likelihood of falls, and because older people often have weaker bones, this can lead to hip fractures - one of the highest causes of death in the older population (Mukamal et al., 2004; Merrick et al., 2008)3.4.

While much research has focused on students and younger adults, little has explored the drinking of older individuals. The evidence in this field is growing, however it is still not adequate to inform an intervention in the area.

So, why retirement? Evidence suggests that those who have recently entered retirement are statistically and significantly more likely to drink almost every day compared to those who are still in work, or those who have been retired for a longer time. At the moment, there is limited support and guidance offered by employers, government and the third sector to those who are retiring in the future. The “Easing the Transition” report from the Drink Wise - Age Well project (Holley-Moore & Beach, 2016)5 suggests that for some individuals, this can be a negative time marred with a loss of purpose, periods of ill health or financial difficulties.

So this is where my PhD comes in, at the moment very little qualitative data exists in this area. We are hoping to interview individuals – not only those who have retired recently and those who are due to retire, but also their employers. This data will then be analysed to establish core themes using a framework approach and fitted to an intervention map to really find a tool that could be used to help people going through this (at times) difficult transition.

From data collection, we will use the findings to begin to develop an intervention that can be implemented in the workplace, or after leaving work. This will be the first protocol of its type that uses the information gathered from those who are going through this transition and will hopefully ease the transition between working and retirement and reduce the growing burden on public health.


References:

1. Wadd, S., & Galvani, S. (2014). Working with Older People with Alcohol Problems: Insight from Specialist Substance Misuse Professionals and their Service Users. Social Work Education, 33(5), 656–669. http://doi.org/10.1080/02615479.2014.919076
2. Stevenson, J. S. (2005). Alcohol use, misuse, abuse, and dependence in later adulthood. Annual Review of Nursing Research, 23, 245–80. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16350768
3. Mukamal, K. J., Cushman, M., Mittleman, M. A., Tracy, R. P., & Siscovick, D. S. (2004). Alcohol consumption and inflammatory markers in older adults: the Cardiovascular Health Study. Atherosclerosis, 173(1), 79–87. http://doi.org/10.1016/j.atherosclerosis.2003.10.011
4. Merrick, E. L., Horgan, C. M., Hodgkin, D., Garnick, D. W., Houghton, S. F., Panas, L., … Blow, F. C. (2008). Unhealthy Drinking Patterns in Older Adults: Prevalence and Associated Characteristics. Journal of the American Geriatrics Society, 56(2), 214–223. http://doi.org/10.1111/j.1532-5415.2007.01539.x
5. Holley-Moore, G., & Beach, B. (n.d.). Drink Wise, Age Well: Alcohol Use and the Over 50s in the UK. Retrieved from www.drinkwiseagewell.org.uk

Photo attribution:

• 'Anonymous Drinker' by David Goehring via Flickr.com © 2013: https://www.flickr.com/photos/carbonnyc/8686574743
• 'Conundrum’ by Robert S. Donovan via Flickr.com © 2010: https://www.flickr.com/photos/10687935@N04/4854800303

Giving Grandmothers a Voice

Guest post by Roz Rigby, a Health Improvement Practitioner at Newcastle City Council and Doctoral student in Public Health at Northumbria University

Today is Grandparents’ Day, a day which celebrates the contributions of grandparents to families and
society overall. Grandparents can have important roles in the health related decisions of families and my research is looking at the influence of grandmothers on introducing solid food. Much of the literature describes grandmothers in a negative light, suggesting they may advise their daughters to start solids before the recommended six months. I found that there was very little research that addressed this from the perspectives of grandmothers’ themselves, and therefore I set out on my research journey with the intention of finding out ‘how do grandmothers make sense of the role they play in introducing solid foods to their grandchildren?’

 I am using constructivist grounded theory methods based on the works of Charmaz (2014)1, and am still finding new meaning in my data, as I try to write up my findings. I am finding this an exciting time in the research, after the arduous task of trying to understand the terminology in qualitative methodology! I must admit that I expected to find grandmothers defending the older methods of introducing solids, which was generally started at around four months, but I actually found that they were open to change and generally accepted the new guidelines. I have also uncovered a complicated web of dynamic family interactions in which grandmothers can struggle to come to terms with competing values of the wider family that they find themselves in. Some grandmothers expressed how marginalised they feel, as they do not have access to the latest information, except through their daughters or daughters in law, and yet, they are often providing extensive childcare.

One of the issues that this research has highlighted for me, is the contested levels of responsibility that grandmothers face. On the one hand they are ‘proxy’ parents, making autonomous decisions about the food that they offer their grandchildren, whilst on the other hand, this can compete with the parents’ decisions and parenting styles (which may in turn be influenced by the other grandparents). Being able to switch this responsibility on and off can cause tension and conflict, particularly if there is a feeding issue. The problems of having a fussy eater can cause parents and grandparents immense distress, with issues of power and control coming to the fore. Grandmothers often worry about conflict within the family and are wary about raising their concerns, for fear of fracturing relationships and possibly losing contact with their children and grandchildren.

Of course it’s not all doom and gloom, as they all report feeling immense love for their grandchildren and a similar nurturing feeling that they had for their own children. They get tremendous satisfaction from these relationships, and I hope that my research will help practitioners to have a better understanding of the issues grandmothers face. I am looking forward to using the findings to develop an intervention that will help families navigate potential intergenerational conflicts and find ways of developing collaboration within families, as they all have the best interests of the children at the heart of what they do.

Reference:

1. Charmaz, K. (2014) Constructing Grounded Theory (2nd Edition). Sage