Alcohol Consumption, Life Course Transitions and Health in Later Life Research Team: Keele UniversityUniversity College of London Clare Holdsworth, PINicola Shelton Marina MendonçaHynek Pikhart Martin FrisherCesar de Oliveira

Presentation Introduction to the project Data and methodology Findings: – Cross-sectional analysis of drinking profiles and health – Longitudinal analysis of drinking quantity and frequency over time Policy implications

Research Objectives To extend understanding of the diversity of patterns of alcohol consumption at older ages; To identify the socio-demographic dynamics of drinking during later life and the life events that are associated with changes in drinking behaviours; To explore the relationship between drinking and health conditions in later life; To establish the importance of secondary survey data in supporting policy initiatives directed towards individual health behaviours; To inform health policy initiatives on drinking in later life through identifying the risks associated with excessive drinking (binge drinking or drinking more than recommended weekly amounts) and the relationship between alcohol consumption, health and well-being in later life.

Data & Methodology ELSA W0 (HSE): Baseline for alcohol variables English Longitudinal Study of Ageing (ELSA): Practice-informed modeling approach in collaboration with Beth Johnson Foundation Cross-sectional analysis: Association between alcohol consumption and socio-demographic and health variables Longitudinal analysis: Sequencing drinking behaviours over life course; link between drinking behaviours and health; identifying whether changes in drinking behaviours are associated with individual characteristics W6 2012/13 W4 2008/9 W5 2010/11 W3 2006/7 W2 2004/5 W1 2002/3

Table 1: Percentage distribution of drinking profiles by gender, wave 0. Drinking Variables Drinking Profiles % Respondents wave 0 Drinking Status Quantity of Alcohol Frequency of drinking MenWomen Non-drinkerNon-Drinker714 Drinker Below Recommended Limits (Men ≤21 units; Women≤ 14 units) Occasional (≤ 4 days) Low Risk: Occasional Drinker 5464 Daily (≥ 5days) Low Risk: Daily Drinker 128 Above Recommended Limits (Men > 21 units Women > 14 unit) Occasional (≤ 4 days) Focal Drinker73 Daily (≥ 5days) Heavy Drinker2011 Number of cases = 11205

Figure 1: Percentage Distribution of Drinking profiles by age and gender: wave 0 Number of cases = 11205

Figure 2: Percentage of drinking profiles with poor self-rated: wave 0 and wave 5 Number of cases = 5868

Figure 3a and b: Unadjusted and adjusted odds ratios predicting poor self rated health: Adjusted for: Age, gender, wealth, social class, education, household size, smoking, BMI

Longitudinal Analysis Multilevel level longitudinal analysis using alcohol variables in waves 0, 4 and 5 Quantity: – Growth curve model of log of weekly units of alcohol consumed – Restricted to drinkers at all 3 time points (3610 valid cases) Frequency – Ordered logistic regression using frequency of drinking in last 12 months – Restricted to respondents at all 3 time points (4740 valid cases)

Figure 4: Average weekly units over time by gender

Pauline: In partnership, Retired, Good health, Some qualifications, Non-smoker, Average Wealth Pearl: Not in partnership, Retired, Not in good health, No qualifications, Non-smoker, Lowest wealth group Doreen: In partnership, Working, Good health, University degree, Former smoker, Highest wealth group Dorothy: During 10 year period: Loses partner, retires & health deteriorates A level qualifications Non-smoker, Above average wealth Age 60Age 70Age 80Age 90Age 50Age 60 Age (11%) (15%) (15%) (22%) Paul: In partnership, Retired, Good health, Some qualifications, Non- smoker, Average Wealth Peter: Not in partnership, Retired Not in good health No qualifications Non-smoker Lowest wealth group Duncan: During 10 year period: Gets married Working, Good health, University degree, Former smoker, Highest wealth group Derek: During 10 year period: Loses partner, retires & health deteriorates A level qualifications Non-smoker Above average wealth Age 65Age 75Age 80Age 90Age 50Age 60 Age (15%) (19%) (17%) (12%) Table 2: Average weekly units consumed for synthetic profiles of older people

Figure 5: Percentage distribution of drinking frequency waves 0 and 5 Number of cases = 4780

Table 3: Summary of results of longitudinal model of frequency of drinking - 1 VariableMenWomen Time (continuous variable)   Partnership status Reference: Always in partnership Always out of partnership Enters into partnership between waves Partnerships ends between waves Employment status Reference: Always in work Always retired  Transition to retirement between waves Health: Reference always in good health Always in poor health   Health worsens between waves Health improves between waves-0.77  

MenWomen Wealth Quintile Reference category: Bottom Quintile 2 nd Quintile 0.48  0.52  3 rd Quintile 0.63  0.80  4 th Quintile 0.75  1.42  5 th Quintile 1.41  1.97  Education: Reference: No qualifications Some qualifications  A-level or equivalent 0.39  0.80  Degree1.41  1.16  Table 3: Summary of results of longitudinal model of frequency of drinking - 2

VariableMenWomen Partnership status * Time Reference: Always in partnership Always out of partnership   Enters into partnership between waves Partnerships ends between waves  Health: * Time Reference always in good health Always in poor health   Health worsens between waves   Health improves between waves Table 3: Summary of results of longitudinal model of frequency of drinking - 3

Main Findings: Drinking, socio-economic status and partnership Older men tend to drink more and to drink more often than women. Men and women in higher income groups and with higher levels of education drink more and drink more frequently. Both the amount that older people drink and how often they drink declines over time. Men who are not in a partnership drink more compared to men with a partner, though there is no difference in the frequency of men’s drinking by partnership status. For women loss of a partner is associated with a faster decline in weekly alcohol consumption and with drinking less often.

Main Findings: Drinking in later life and health Poorer self-rated health is associated with not drinking. Among drinkers, there is no evidence that a moderate amount of alcohol consumption improves health in later life compared to heavy drinking. Over time older people with poor self-rated health and deteriorating health report a steeper decline in the quantity and frequency of alcohol consumed (similar finding for depression). Those who stopped drinking at the start of the period of observation and remained in the study were more likely to experience an improvement in health compared to drinkers.

“The public health message should be make sure you’ve got things in place, go and make friends, you know, get you life organised so that you’re enjoying it because I think again anecdotally a lot of men don’t maintain contact with people” Policy Implications Rethink causality between health and drinking in later life? Older people moderate their drinking if their health declines. But the message that moderate drinking is good for you is not supported by this analysis. Furthermore for this sample we did not find that excessive drinking causes a deterioration of health in later life. Those who stopped drinking were more likely to experience an improvement in health compared to drinkers so cessation may be recommended for older people in poor health. Those at most risk of drinking in excess and drinking most frequently are well educated and have high wealth. This is a concern particularly as the prosperity of older people improves then this may lead to more people drinking excessively in later life. This group of successful older people could be resistant to public health messages. Partnership makes a difference to how much older people drink though this differs for men and women. The social context of drinking is important and advice about drinking needs to be sensitive to partnership status.