Theres more to life than a drink: Older peoples ideas about how to reduce the harm of alcohol in County

Durham

A report to Durham County Council February 2013

Age UK County Durham Older people and alcohol February 2013

This word cloud shows the key triggers that cause older people to drink alcohol identified by the participants in this study. Words are larger where they were mentioned more often.

Age UK County Durham Older people and alcohol February 2013

Contents Page
Page 1. Executive Summary 4 2. Introduction .. 6 2.1 Background 2.2 Methodology 2.3 Representation 6 7 8

3. Why do older people drink alcohol? 10 3.1 Summary 3.2 Triggers 3.3 Perceptions 3.4 Culture 10 11 12 14

4. Who or What can influence older people about alcohol .. 16 4.1 Summary 4.2 Who can influence older people about alcohol consumption? 4.3 What can influence older people about alcohol consumption? 16 16 19

5. How to reduce alcohol consumption among older people 20 5.1 Summary 5.2 How to reduce alcohol consumption among older people 5.3 Social interaction 5.4 Alcohol awareness 5.5 Counselling and support 20 20 21 22 26

6. Minimum price campaign for alcohol 26 7. Conclusions and recommendations . 27 7.1 Conclusions 7.2 Recommendations 27 28

Age UK County Durham Older people and alcohol February 2013

1. Executive summary
Alcohol misuse among older people is associated with an increased risk of falls, poor nutrition, hypothermia, anxiety and depression. Factors that can trigger heavy drinking in later life include loss, bereavement, loneliness, isolation and coping with pain or ill health. Alcohol can also have an interaction with prescribed medications. Alcohol misuse is thought for the most part to be unreported, undiagnosed, or ignored. There is concern that in County Durham over the past 9 years there has been a 290.2% increase in over 65+ alcohol related hospital admissions.

This report presents the results of a countywide consultation commissioned by Durham County Council and carried out by Age UK County Durham to understand why older people drink alcohol and identify actions which might reduce the harm caused by alcohol consumption.

This report draws together the results of consultation with 140 people aged 50+ through 10 focus groups, 3 one to one interviews and a questionnaire returned by 80 people. The information collected will be used to inform the Alcohol Harm Reduction Strategy for County Durham.

The consultation identified that the main triggers that caused older people to drink alcohol are loneliness, boredom, depression, bereavement and pain or illness. Socialising and celebration were seen as much lower. Alcohol was seen as an aid to sleeplessness, a pain killer to numb pain and as a stress reliever.

The main influencer in relation to alcohol consumption is the GP and other healthcare professionals and many older people admitted they have concealed their alcohol consumption from their GP as they were worried they would not receive medical treatment if the GP knew they drank. Family are also important influencers and their support can make a big difference.

When asked how to reduce alcohol consumption among older people there was a consensus of opinion;

Age UK County Durham Older people and alcohol February 2013

Opportunities for social interaction in non-alcohol based activities; Awareness raising about the impact of alcohol consumption; Support through counselling or Listening Ear services.

The report makes 5 recommendations which are given in section 7 of this report.

Age UK County Durham Older people and alcohol February 2013

2. Introduction
This report presents the results of a countywide consultation commissioned by Durham County Council and carried out by Age UK County Durham to understand why older people drink alcohol and identify actions which might reduce the harm caused by alcohol consumption.

This report draws together the results of consultation with older people through focus groups, interviews and a questionnaire. The information collected will be used to inform the Alcohol Harm Reduction Strategy for County Durham.

2.1 Background

Durham County Council have identified that the percentage of people who drink above recommended units decreases from the age of 45 years onwards. However the chronic health damage from prolonged alcohol misuse is more likely to manifest itself as we get older. In County Durham over the last nine years there has been a 290.2% increase in over 65+ alcohol related hospital admissions. The rate increase for 65+ males has been slightly higher at 301.2% whilst being slightly lower for 65+ females at 273.5%. The crude rate of 65+ admissions as of 2010/11 was 3.8% lower than the North East average but 20.1% higher than the national average 1. Alcohol misuse among older people is associated with an increased risk of falls, poor nutrition, hypothermia, anxiety and depression. Factors that can trigger heavy drinking in later life include loss, bereavement, loneliness, isolation and coping with pain or ill health. Alcohol can also have an interaction with prescribed medications. Alcohol misuse is thought for the most part to be unreported, undiagnosed, or ignored.

In 2011 the Chief Medical Officer suggests that 20% of men and 10% of women aged 65 and over exceed recommended drinking guidelines and 3% of men and 0.6% of women aged 65-74 are alcohol dependent. Nearly 20% of the population in County Durham is of pensionable age (60 or over for women, 65 or over for men). People of
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Draft Alcohol Harm Reduction Strategy for County Durham, Durham County Council, 2012

Age UK County Durham Older people and alcohol February 2013

pensionable age make up a larger proportion of the population in County Durham (19.8%) than in England (18.5%). By 2029 it is projected that 28.9% of the population in County Durham will be over the (current) pensionable age.2

The social marketing group involved in the alcohol harm reduction strategy agreed to progress work with older people in line with the Joint Commissioning Strategy for Older People Action Plan 2012/13. The aim was to establish level and type of need of older people with alcohol dependency problems and older carers of relatives with drug/alcohol dependency problems. The group asked Age UK County Durham to undertake some research about alcohol with older people to identify their knowledge of alcohol units, the reasons behind alcohol use by older people, sources and types of alcohol, the impact of stigma and alcohol, and to contribute suggestions for actions to support the alcohol harm reduction strategy.

2.2 Methodology In total this consultation has involved 140 older people across County Durham. We encouraged older people to participate in this consultation using a number of approaches: Consultation with focus groups of older people One to one interviews with older people Questionnaire distributed to EngAge Older Peoples Network Articles in the Northern Echo inviting older people to participate

There were 10 focus groups, 3 interviews and 80 people participated by questionnaire. The consultation breakdown is as follows: 1 x group of carers 4 x Older Peoples Network groups 3 x focus groups of EngAge members 1 x 50+ LGBT group Members of a Confident Consumer Group 3 x one to one interviews 80 questionnaire respondents
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Draft Alcohol Harm Reduction Strategy for County Durham, Durham County Council, 2012

Age UK County Durham Older people and alcohol February 2013

Each focus group was designed to take 1 hours and followed a plan agreed with the Alcohol Harm Reduction Coordinator. All participants received a complimentary Unit Measuring Glass, a self-screening toolkit and a colourful information pack of leaflets to take away. Each group were introduced to the subject and then asked to share their views on a range of questions including: Awareness of alcohol units What triggers may encourage people to drink What would support an older person in reducing their alcoholic intake Who or what would an older person take notice of when asked to cut down their alcohol consumption? How could we reduce alcohol consumption amongst older people in County Durham? What does the group think about the Governments idea of a minimum price for alcohol?

2.3 Representation Effort was taken to ensure coverage from across County Durham and to involve older people of all ages, those with disabilities and carers.

Participants included older people from across the county (please see Table 1).

Geographical area Dales Derwentside Durham & Chester-Le-Street East Durham South Durham Not given

Number of people 20 32 44 24 15 5

Table 1: Breakdown of participation across County Durham

Age UK County Durham Older people and alcohol February 2013

We involved 140 older people aged 50+ . The table below gives a breakdown of the ages (please see table 2).

Age 50-64 65-74 75-84 85+ Total

Focus groups & interviews 9 26 20 5 60

Questionnaire 17 41 19 3 80

Total 26 67 39 8 140

Total as % 18 48 28 6 100

Table 2: Breakdown of participation by age. Of the participants: 32% are male, 68% are female 18% are older carers 4% are housebound 54% consider themselves to have a disability with 39% having physical disability, 29% have hearing loss, 14% have visual impairment and 6% have a mental health problem. 88% are heterosexual, 4% are gay men and 2% are lesbian / gay women, 6% did not state.

Age UK County Durham Older people and alcohol February 2013

3. Why do older people drink alcohol?

3.1 Summary There are many reasons why older people have an alcoholic drink. We asked participants in this consultation to tell us about their own drinking habits and what factors led them to drink alcohol. Many also talked about the impact of alcohol on friends or members of their family. Across the county and through interviews, focus groups and questionnaires, many identified the same triggers that led older people to drink alcohol. These triggers include loneliness, boredom, bereavement, depression and habit. Other factors are linked to perceptions (a tot of whisky is medicinal, a glass of red wine is good for you, only alcoholics have a problem) and also a culture of drinking after hard physical work in heavy industry which then continues into retirement.

3.2 Triggers Among the 80 questionnaire respondents, the most commonly identified reason for drinking alcohol was loneliness. In this study, 76% of questionnaire respondents said this was a main trigger for themselves or those they know. Boredom and depression were the next most common triggers with 31%, followed by bereavement with 25% and pain or illness identified by 24% of respondents. Socialising (11%) and celebration (10%) are less common triggers than low mood and isolation (please see Figure 1 overleaf).

Comments from questionnaire respondents included some strongly worded statements; alcohol consumption among older people is a topic that people feel strongly about. We are bored and lonely, theres nowhere to go, nothing to do, transport facilities are very weak; we suffer from constant government pressure and we worry about our lack of income / managing to pay bills etc. Drink might be seen as a tool to help someone relax or sleep when faced with the empty bleak existence like ours. What else can a person do to escape the horror of life? Questionnaire respondent

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Triggers for older people to drink alcohol

80 70 60 50 40 30 20 10 0 % of respondents

Figure 1: Triggers that cause older people to drink alcohol identified by questionnaire respondents

Participants in the focus groups discussed their own triggers. These included: Boredom; Pain relief; Depression; Relationship problems; Stress relief If you have had a hard day it is easy to come in and pour a glass of wine. Its a reward after a busy day. (Focus group participant) Having it in the house. If you know its there, you want it (Focus group participant) Socialising with people who are drinking; Keeping up with others drinking in rounds; Availability of affordable alcohol The supermarkets almost throw alcohol at you! (Focus group participant); Drink does sneak up on you it becomes a habit and can become alcoholism (Focus group participant); In Scotland the alcohol measures are bigger than in England (Focus group participant);

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Age UK County Durham Older people and alcohol February 2013

To unwind at the end of the day Warm and comfy at home, we enjoy a drink when relaxing (Focus group participant); I like a whisky but it would be after I have walked the dog. I like it with a drop of green ginger and hot water to combat the cold. (Focus group participant) It is a comfort thing, it warms me up. (Focus group participant) I know friends who share a bottle of wine with dinner every night. (Focus group participant) I dont drink but I would take it for a heavy cold to help me breathe. (Focus group participant) Whisky, sugar and hot water, no lemon, it works for me as medicinal. (Focus group participant) I have a cupboard full - I bring it back from holidays. (Focus group participant) At a funeral the drinks get passed around; There is nothing secret about my drinking habits. I like a wine and a whisky. (Focus group participant) Im not an alcoholic. I drink every day. I dont think it is doing me any harm. (Focus group participant) I have brandy in the house it heats you up and stimulates you. When I am very low and poorly I take two teaspoons in milk, its like a tonic. I doubt poorly people will over drink. The brandy goes right to the spot of the discomfort. (Focus group participant)

3.3 Perceptions During the discussions in the focus group a number of perceptions were identified including: That some people with a higher tolerance level can drink safely; That you can line your stomach and drink more; What you can drink SAFELY depends on what you are used to; A glass of red wine is good for us; A hot toddy sounds more medicinal. Many people perceive that a drop of spirit is medicinal;

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It is only alcoholics who have the problem. These are seen as persistent drinkers, abusive, drunk, violent, causing trouble. It took a while for one group to acknowledge that an alcoholic could also be a secret drinker, a social drinker or someone they know. There was a perception that spirits are better for you as they are more natural and less processed. There is a difference between what you drink. Whisky is better than lager. You cant drink as much spirits as you can lager. Spirits are not as bad on the body. Spirits can take 12 years to make, whilst lager is 3 weeks. Focus group participant

General comments around older people and alcohol consumption There was a great deal of discussion about alcohol in the focus groups, its effects on themselves and people around them. There is concern that older people could become more vulnerable when drinking, for example open the door to strangers. Participants often agreed that there is a great deal of self denial around alcohol consumption. People dont admit things; they might have a fall but do not blame this on their drinking. Focus Group participant

People drink in secret due to a perception of what older people should be doing. There is a stigma. Older people who have a drink dont admit it. Society is a lot to blame. It places restrictions on older people. Older people dont have sex either. My family would be fine with me getting a fella at 74, others wouldnt. Drink is viewed in a similar way older people shouldnt do it. Focus Group participant Doctors dont know that people drink or how much they drink. People lie. Focus Group participant

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A number of focus Group participants and questionnaire respondents defended their right to have a drink. Similar comments to the following were made in focus groups and by questionnaire respondents. How much time have I got left what harm will it do now? (Focus group participant) TV every time you watch TV they are pouring wine. You see it all the time could make you want a drink. (Focus group participant) I have a glass of wine with my meal at night on my own. I have white wine. I always have it in the house and never have more than one glass. I enjoy it. I mentioned it to my GP and he said Why not? it wont do you any harm (Focus group participant);

Some participants have experience of alcohol dependency and told us their stories. Ive no alcohol in the house now I gave it all away. It was starting to get to me. I fell down the front steps at home I was trying to fly! The white rum was on offer at the club and it was cheap, the house special. I was drinking trebles and at home. I was lucky I hurt my back. When I went to the doctors the next day I didnt tell him I had been drinking and he didnt ask. I thought if I told him he wouldnt send me for the X-ray. My friend told me it was time to pack it in and keep off the shorts. I used to have a bottle and think nowt about it. One to one interview

3.4 Culture Focus group participants often identified that the North East has a reputation and history of hard drinking because of culture in heavy industry, mining, ship building, and steel industry. People worked hard under difficult circumstances and sweat had to be replaced. Alcohol was considered to work better than water. The last of that

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Age UK County Durham Older people and alcohol February 2013

generation are probably the older ones now so there will be a generation change. Focus group participant

Some members agreed that by necessity, doing a certain type of work gave you dust, and you had to lay the dust with a pint in a little group at the pub. That culture of work place was relevant even when someone didnt work anymore. A habit formed after a lifetime of work. Many older men told us that they will go to the Working Mens Club or their local pub to have company and some social interaction to relieve loneliness, isolation or the stress of caring. They will watch the sport on the TV, chat to others and have a drink. Men who used to go on the drink in the evening, now go on an afternoon and go to bed early. There is risk of trouble in the evening and men dont like to leave their wife at home alone. Men go to the Working Mens Club. People go for the conversation and company. They put a bet on; have a pie and a drink. Focus group participant I know a fella who used to have 5 - 6 pints in his 40s but can now only manage 2 3 pints. He is 76 years old and goes out on an evening. He goes out 5 nights a week and Sunday morning. He has vertigo now so he has cut down on his drinking. Focus group participant

We have made alcohol a part of our lives now. Focus group participant I have bar lunches at the pub, I have a drink with mine because I enjoy it. It helps me unwind. I have a very stressful life caring for my wife. I live in an area that I dont know, with no friends, and my wife doesnt know what day of the week it is. The pub is a good place to talk to people and socialise. A pint does me far more good than a glass of orange. I never look at the price. I usually drink at home. I have a pint with every bar meal. I wouldnt think that it is doing me harm although I could do with losing a couple of stone. Focus group participant

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Age UK County Durham Older people and alcohol February 2013

Participants often agreed that older people dont go out at night as much as they did when they were younger, especially in the winter. Also drinking in pubs can be expensive. This leads to them having a drink in the home and many told us that they live alone and will drink on their own. Older women in my church are in their 70s and have a hot toddy every night. They dont see it as a problem at all. Its not secret. Focus group participant My friend took a bottle of whisky to bed. He is over 70 years of age and drinks on a regular basis. He says he needs a small amount to help him get to sleep, but he is drinking a lot more than he used to. Focus group participant

4. Who or what can influence older people about alcohol?

4.1 Summary We asked participants in the focus groups and our questionnaire respondents to tell us who or what could have enough influence on an older person to get them to take serious notice of their alcohol consumption. Where should a message be placed and where do older people access help? The majority of questionnaire respondents (58%) told us that a GP or other healthcare professional would have the most influence on an older person who was drinking too much. This was followed by family (35%) and friends (15%). When asked what might get the attention of an older person, 5% said becoming ill or having an accident as a result of alcohol consumption. However, 10% of people said there was no-one or nothing that would influence them.

4.2 Who can influence older people about alcohol consumption? We asked people who they thought could have enough influence over them or other older people they know to get individuals to take notice of their alcohol consumption.

One focus group participant told a story of her friend who she goes on holiday with.

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I take my friend on holiday twice a year. On holiday she drinks to excess. I think she thinks she has to get her moneys worth as it is all inclusive. She has a brandy in her coffee at 10am; I have to escort her to lunch as she has drunk too much. She has a sleep on the afternoon and then starts drinking again at 4pm. She drinks a lot at home too; it just gets worse on holiday.

She always has a whisky in her coffee when she visits me. She is not bothered by her drinking at all. She is 85 years old. She is so embarrassing. If I say anything to her she tells me I am nagging, a spoil sport, she doesnt care. I have given up preventing the alcohol now; I now prevent any accidents occurring because of it. Focus group participant

It is interesting to note that whilst the other participants were listening to the story, the facilitator noted that everyone laughed when the ladys age was mentioned. They all thought it was too late to do anything about it.

Many participants told us that spending time with young members of the family, especially grandchildren influence them greatly as they would not want to drink alcohol in front of them or appear intoxicated. Participants identified that family members can both be a trigger for drinking alcohol (family arguments, domestic abuse) and also the source of great support. It is lonely being on your own. I was a carer for 20 years so I could have easily turned to drink, but I didnt. I have family support. This is the biggest thing you can have. Focus group participant

If close family are made aware of the damage to health caused by over indulgence of alcohol they would be a powerful influence on the older person. The peer group similarly although they may be part of the problem rather than the solution. Questionnaire respondent

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Age UK County Durham Older people and alcohol February 2013

Questionnaire respondents identified that healthcare professionals (GP, nurses, Consultant, Care Team or other medical staff) are key influencers when it comes to alcohol consumption (58%). Many people said members of their family could influence them (35%) and 15% of respondents told us that friends would influence them. The chart below shows the key influencers of opinion (please see figure 2).

Who or what would influence an older person's attitude to alcohol?

70 60 % of respondents 50 40 30 20 10 0 GP / Health professional Friend Family member Influences Becoming ill Nothing

Figure 2: Health professionals were identified as the most likely to influence an older persons attitude to alcohol (questionnaire respondents)

Focus group participants recounted stories of medical tests or check ups which had influenced them enough to make them change their lifestyle. They told us their GP would be taken more seriously than a friend trying to influence them (sometimes friends can be part of the problem). A number of participants told us that they had told their GP how much they drank and that they had been reassured that it was acceptable. Others told us that it was a stern instruction from their GP that shocked them into reducing or stopping their alcohol intake. Family and friends had spoken to me about my drinking but this did not have an impact. There is a lot of denial in drinking. I used to drink 3 litres of White Lightening and 2 bottles of Jack Daniels a day, plus go to the pub for a few pints. It was a shock from the GP that made me give up alcohol. I went to see 18 Age UK County Durham Older people and alcohol February 2013

the GP for pain in my shoulder after a fall. The GP sat me down and said if I didnt stop drinking I had only 3 months left to live. This was what made me take notice. I had to stop drinking completely rather than just cut down. I had a seizure after I stopped drinking which was a very scary experience for me. Focus group participant

4.3 What could influence older people to reduce their consumption Questionnaire respondents and focus group participants had similar suggestions about what would make older people take notice of the need to reduce their intake. These are:

A health scare; A fall caused by intoxication; A reaction to medication mixed with alcohol; Friend or family member being very ill or dying as a result of alcohol; Being presented with information about the harm that can be caused by alcohol consumption (including the gory details); Increased price of alcohol; Support from family members and spending time with grandchildren.

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Age UK County Durham Older people and alcohol February 2013

5. How to reduce alcohol consumption among older people

5.1 Summary We asked older people to suggest ideas to reduce alcohol consumption amongst older people in County Durham. There was a great deal of consensus among participants about how to achieve this. Participants said they would like to see:

Opportunities for social interaction that provided an enjoyable distraction from alcohol. Suggestions included arts and crafts, physical activity and exercise, learning IT, friendship groups and lunch clubs, developing hobbies and interests that could occupy people during otherwise lonely evenings.

A strong awareness raising campaign that would not be patronising but would get the message across that older people process alcohol differently as they may have a different diet, often weigh less and often take regular medication that may react to alcohol. The campaign should make older people aware of alternatives to alcohol and provide opportunity or encourage them to try different drinks. There was agreement that the GP should be involved but an awareness of how busy they are. Older people would listen to informed strangers and they would like to hear from people who have overcome alcohol problems.

Counselling and support should be available to older people. Some people asked for a Listening Ear service that could be local, others saw a need for more specialist counselling.

5.2 How to reduce alcohol consumption among older people

The questionnaire respondents were very clear about how to help older people drink less alcohol (Please see Figure 3 overleaf). Opportunities for social interaction to reduce loneliness and isolation (76%), Raising awareness about the dangers of alcohol consumption (19%) and Access to counselling, support and listening ear services (19%).

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Suggestions to reduce alcohol consumption among older people

80 70 60 50 40 30 20 10 0 Social interaction Alcohol awareness Suggestions Counselling & support % of respondents

Figure 3: Questionnaire respondents identified that opportunities for social interaction are needed to help older people reduce their alcohol intake.

Participants in the focus groups also presented the same solutions to reducing alcohol consumption by older people. We were able to explore some of these in more detail within the groups.

5.3 Social interaction We saw from the questionnaire that 76% of respondents told us that older people turn to alcohol because they are lonely and isolated. Both questionnaire respondents and focus group participants told us that the solution is to provide opportunities for different types of activity to promote social interaction and stop older people turning to alcohol.

Although it can be difficult to make new friends in later life, participants told us that this can be greatly helped by community based activities where older people can meet others who have lost long term friendships and enjoy companionship, contact with others and something to look forward to. Many people said that evenings were lonely for them and a trigger for having an alcoholic drink. Those who did have a hobby or interest to keep them occupied in the evening told us that helped them to be busy and prevented loneliness. 21 Age UK County Durham Older people and alcohol February 2013

Specific social interaction activities suggested include:

Activities with people with no alcohol; Art & Craft clubs such as music, writing, acting, painting, singing; IT classes; Trips out / travel clubs; Exercise / get active activities; Group activities, friendship clubs, dinner clubs, WI / Townswomens Guild / University of the 3rd Age; Getting involved in voluntary activity; A befriending service. Someone to keep in touch, share information and help people take part in activities. It was suggested that this needs volunteers who know whats on in the area; A visiting service for the isolated and lonely. This would give people something to look forward to; Lunch clubs meet for lunch and then do more activities later; Whilst discussing befriending in one focus group, a participant asked How many people would be happy to befriend others? The people who need support would be lonely, isolated. Lonely old people could be abusive. Who wants to do the job? A few people then responded that they would like to do it.

5.4 Alcohol awareness People need to understand the real downfalls of alcohol and the damage not only to themselves but to whom and what gets in the way as the disease gets further control and leads to severe addiction. Focus group participant

Questionnaire respondents and focus group participants suggested that it is important to raise awareness of the harm that alcohol can do (including even the gory details). Many participants said they felt an intensive programme of publicity was

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probably needed, similar to the one for smoking awareness as people need to first recognise they have a problem before they reduce their intake. They suggest that you need to get the message out there that older people process alcohol differently. They suggested a number of ways of doing this.

Getting the message across Many participants were concerned that simply handing leaflets out will not work and that older people will feel resentful if they feel they are being patronised. There were suggestions that Carers who may buy the alcohol for the older person need to be aware of the risks. They suggested having a pro-active approach that involves sharing information amongst older people would work with efforts made to target sheltered accommodation and bungalows. Participants felt that you have to recognise that you have a problem but suggested that by increasing the awareness of the problem it will eventually penetrate to those with a problem. Participants told us to be careful how the message is communicated. People dont easily take advice; they say Im 70 years old and Im not going to change (Focus group participant). It needs to be advice rather than an order. Its my life so I will do what I want. Focus group participant People can feel like they are being preached to, that you are having a go at them if you comment on their drink intake. My friend knows it is for his own good but he does not want to hear it. Focus group participant

Importance of using medical information Given the influence of healthcare professionals on older peoples attitudes, it is not surprising that many participants suggested that medical information should be used to raise awareness of why older people should reduce their alcohol intake.

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Clarify the mixed messages from the media. Focus group participants told us they are confused by the conflicting messages such as Red wine is good for you or that there are safe levels of alcohol consumption. I feel it is medical information which would be most useful in reducing someones intake. Showing someone the damage that is being caused to their body. Similar to the stop smoking campaigns and have a real push to raise peoples awareness. I think pictures on bottles would be good. These should show pictures of ill people not just a damaged organ. There is more impact with a picture of a jaundiced person or someone with mouth cancer than just a damaged liver. Focus group participant

Make people aware of the side effects of alcohol on medication. These should be made clear to people and then they can make their own minds up. The GP only reminds us sometimes, you should always check the instructions. Focus group participant

Photos should be made available of the deterioration of human organs due to excessive alcohol practices and the cost involved to treat patients who took very little or no notice of GPs warnings. Focus group participant

The role of GP and healthcare professionals The family GP and healthcare professionals have already been identified as key influencers and participants. Participants identified that they have a key role to play in getting the message across and that older people who drink alcohol regularly need guidance and advice from their GP. There were suggestions that hospitals should inform GP that a patient was admitted to hospital and alcohol was a contributory factor.

However, participants are aware that GPs are very busy and that whilst they are the right place, they have no time or support to find out how much you are really drinking and can probably do little more than give people a leaflet. It was suggested that perhaps a nurse in the surgery or health centre could have this role? Some

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participants suggested the GP could have a pack to give to people to introduce them to activities and alternatives to alcohol.

Hearing the message from strangers Participants said they would listen to informed strangers and people who were speaking from experience. I would be more influenced by someone who is a drinker and medically unwell speaking to me. It would need to be extreme to get people to take notice. Focus group participant

Hearing of other peoples actual experiences could help. I was shocked to find out that a person can drink enough alcohol to damage their liver without ever being drunk. This is not the image presented by the media of physical damage from alcohol. Focus group participant

The information needed Participants told us that they liked the message that older people process alcohol differently. They suggested the use of good slogans and repetition. The information about units and safe drinking is far too complicated. A simpler way of getting the message across is needed just like the 5 a day message What about two days a week to encourage abstinence on at least two days of the week? Anyone can remember two alcohol free days a week. How safe is 4 units a day when you are doing it every day? You need to break the habit. You can start in easy stages and do just one day a week. Focus group participant

Suggesting alternatives Participants would like to get more ideas about alternatives to alcohol. Raise awareness about non-alcoholic drinks with opportunity to taste the products and also to be made more aware of how to have a healthier lifestyle.

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Focus group participant Age UK County Durham Older people and alcohol February 2013

Encourage different ideas for rewarding self Focus group participant

5.5 Counselling and support As it was recognised that many older people drink alcohol because of depression, habit and stress, many participants suggested different forms of individual support could help people. These varied from a Listening Ear service (telephone helpline or local drop in) to support groups and addiction support. The important factor was that older people who drink alcohol need empathy from health care professionals.

6. Minimum price campaign for alcohol

There was lively discussion in the focus groups about the 50p per unit campaign.

Participants generally supported the campaign and felt that the minimum price of 50p per unit would not affect them greatly as it would only be a few extra pounds.

However, there is concern that those who drink a lot of alcohol will continue to drink but people would find the money from somewhere and sacrifice essentials such as food and heating. There is also a fear that people may turn to a black market for alcohol or to crime to find the extra money.

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7. Conclusions and recommendations

7.1 Conclusions The majority of older people have heard the term units applied to alcohol and have some level of awareness of how it equates to beer, wine or spirits. Very few people measure their units if they drink at home, they would just pour out what they want.

There are a number of reasons why older people drink, these are linked to Culture men would gather together at the pub or club to lay the dust or relax after working in the traditional heavy industries and this practice continues into retirement. People drink because they are lonely. This may be due to living alone, bereavement, depression or boredom. With older age comes loss of friends and physical or sensory impairments can impact on social interaction and people find themselves at home and alone. Lack of awareness. Many older people consider whisky or brandy to be medicinal (as a result they hardly count as alcohol) and use it to combat colds. There is an understanding that red wine is good for you. The availability of alcohol sold cheaply in the supermarkets means that older people can afford to have alcohol in the home and once in the home, they will drink it.

There is a stigma surrounding drink and those who drink too much will often conceal this from their GP as they worry that they will be refused treatment. However, the GP and other healthcare professionals are considered the most influential people when needing to advise an older person to reduce their alcohol consumption.

Actions to reduce alcohol consumption amongst older people fall into 3 main categories: Opportunities for social interaction in non alcohol based activities; Awareness raising about the impact of alcohol consumption; Support through counselling or Listening Ear services.

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Age UK County Durham Older people and alcohol February 2013

Older people are generally supportive of the 50p per unit campaign and a minimum price per unit for alcohol. They are concerned that some people with an alcohol addiction problems will sacrifice other essentials such as food and heating to pay for alcohol or that people may turn to the black market or crime to find the money.

7.2 Recommendations

1. Social marketing campaign with a simple and non-patronising message that can be used by GPs, healthcare professionals and professional staff from other agencies such as Age UK County Durham to get the message across.

2. To use the suggestions in this report to help develop the campaign, such as the pro-active outreach approach, a simple message repeated and reinforced, and images showing the impact of alcohol consumption.

3. Development of a colourful and informative pack that explains the facts to older people which can be distributed through a range of agencies.

4. Promotion of existing opportunities for older people to access to relieve loneliness, isolation and boredom.

5. Exploring the potential for funding to develop additional opportunities for social interaction or services such as befriending or counselling where there are gaps in existing provision.

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Age UK County Durham Older people and alcohol February 2013