Intended for healthcare professionals


Alcohol consumption limits should be lowered for over 65s, say psychiatrists

BMJ 2011; 342 doi: (Published 21 June 2011) Cite this as: BMJ 2011;342:d3950
  1. Jacqui Wise
  1. 1London

Government guidelines on safe limits for drinking should be lowered for people aged over 65 years to 1.5 units a day for men and 1 unit a day for women, the Royal College of Psychiatrists recommends.

Our Invisible Addicts, written by the college’s working group on older people’s substance misuse, says that physiological and metabolic changes associated with ageing mean that the current safe limits are too high for elderly people. It says that binge drinking should be defined for this age group as more than 4.5 units in a single session for men and more than 3 units for women.

Launching the report, Tony Rao, consultant in old age psychiatry at South London and Maudsley NHS Foundation Trust, said, “For a given volume of alcohol, the rate it is got rid of from the bloodstream is a lot lower in older people. Also older people tend to have a range of other health problems and may be taking many other prescription medicines that interact with alcohol.”

Ilana Crome, professor of addiction psychiatry and chairwoman of the working group, said, “Forty percent of NHS dispensed prescriptions are to the over 65s. It doesn’t take much alcohol on top of prescribed benzodiazepines to make someone confused and wobbly and then have a fall. They then end up in hospital with a fractured femur.”

Professor Crome said that a lack of awareness means that GPs and other healthcare professionals often overlook or discount the signs when someone has a problem. “They don’t need to be a stereotypical junkie or alcoholic in the gutter to have a serious problem,” she said.

The number of elderly people in the UK population is rising rapidly. A third of older people with alcohol use problems develop them in later life, often after life changes such as bereavement.

Dr Rao said, “We are witnessing the birth of a burgeoning public health problem in a baby boomer generation of older people for whom alcohol and drug misuse is growing.”

The report also warns that illegal drug use, though currently uncommon among over 65s, has been rising significantly among the over 40s in recent years. As this generation reaches old age the problem is likely to get worse.

It recommends that GPs screen every person aged over 65 for substance misuse as part of a routine health check, by using specific tools such as the short Michigan alcoholism screening test, geriatric version (SMAST-G).

Stefan Janikiewicz, a GP and clinical director of the substance misuse service in Cheshire and Wirral Partnership NHS Trust, said, “Some GPs do already look out for substance misuse, but a lot don’t.” He added: “I would like to see the government include substance misuse in the QOF system [the quality and outcomes framework, used in England to reward GPs for the care they provide to patients], then we would see a massive change in practice by GPs.”

The report also calls for all doctors, nurses, psychologists, social care workers, and allied health professionals to be given suitable training in substance use disorders in older people. It says that there is accumulating evidence that treatment of alcohol and drug misuse in this age group is effective and that older people often stay in treatment for longer than younger people.

The report calls on the government to develop public health campaigns concerning alcohol and drug misuse that are specifically targeted at elderly people. Owen Bowden-Jones, chairman of the Royal College of Psychiatrists’ faculty of addictions psychiatry, said, “We need to get the message across to older people that your body is not able to cope with substance misuse in the same way as it did when you were younger.”


Cite this as: BMJ 2011;342:d3950

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