It’s no secret that our planet is ageing – and not just in terms of the physical entity we live on.

The world is facing a demographic timebomb with the scales tipped firmly toward older adults.

Global life expectancy a century ago was just 34 years. Now, thanks to medical advances and improved standards of living, the average life span has soared to 72 years.

As the last of the baby boomer generation born between the end of the Second World War and the mid-1960s move into their retirement years, the number of older people is expected to significantly outnumber children under the age of 10 by 2030 – 1.41bn versus 1.35bn – according to the United Nations.

Projections indicate that by 2050 those aged 60-plus will account for 2.1bn of the world’s population compared to just two billion adolescents and youths aged 10-24.

Good as it is that we all have the potential to live longer, it brings with it a host of problems, not least on the healthcare front. One challenge facing healthcare professionals is the rising rates of alcohol use in older adults.

Drinking too much can have an adverse physical and mental impact on anyone of any age, whether it be mood swings, heart and liver problems, or an increased risk of cancer. But age-related changes in the body put older adults at heightened risk as they typically metabolise alcohol less quickly and feel its effects more keenly than younger people do.

This – coupled with the fact many older adults are taking a cocktail of prescription medicines that often don’t mix well with alcohol with sometimes dangerous and even fatal consequences – is much cause for concern.

Jeppe Tryggedsson

Often, however, health professionals are loath to persuade older people to seek help with their alcohol abuse due “to a misguided notion that alcohol might be the last thing providing them with a quality of life,” Jeppe Tryggedsson, a PhD student at the University of Southern Denmark, told Agetech World.

But a new study from UCAR – the Unit for Clinical Alcohol Research at the University of Southern Denmark – suggests that even a modest reduction in alcohol consumption and participation in a treatment programme can make a significant difference for individuals aged 60-plus with a notable liquor intake.

The research has shown that older adults undergoing treatment experience an improved quality of life, whether they choose to abstain from alcohol entirely or reduce their consumption.

Now Tryggedsson, a candidate in public health science and lead author of the study, hopes the work carried out by him and his colleagues, will dispel the myth that older adults with alcohol use disorder, don’t necessarily need treatment.

Speaking to Agetech World, he said it had been noted that individuals who completely abstain from drinking and those who reduce their intake both experienced improvements in quality of life.

This improvement extended across all domains – mental, physical, social, and environmental.

He explained: “In our study, the quality of life of older adults suffering from alcohol use disorder does not decline following treatment. On the contrary, it improves, at least slightly, both overall and within various domains.

“These improvements are not only maintained over time but also keep increasing up to one year after initiating treatment. Thus, quality of life measures is still significantly greater one year after treatment entry compared to baseline measures.

“We were also able to show that these improvements might also be achievable in patients with a reduction goal as a treatment outcome, and not only for patients who obtain abstinence after treatment.

“This knowledge is highly relevant for healthcare professionals who tend to believe that either there is no perspective in offering treatment for older adults late in life or that alcohol reduction is not a feasible goal for the older adults who aim for it.”

Tryggedsson said addressing this reluctance among healthcare professionals was particularly important, “since it is probably a part of the explanation of why older adults are less likely to receive treatment compared to other age groups.

“Overall, our results indicate that it would be highly beneficial to convert this attitude of reluctance to treat older adults for their excessive alcohol use and further improve treatment options for older populations.

“Furthermore, it may also be relevant to continuously convey to patients that improvements in quality of life continue over time, to help prevent a feeling of hopelessness.

“It is my overall hope that more people with problematic alcohol use will use this knowledge to seek treatment.

“Hopefully, our study will encourage individuals, family members, and peers, to believe that there are feasible alternatives to drinking late in life, regardless of age and gender.”

The researchers used data from the Elderly Study, a multinational, randomised controlled clinical trial conducted between January 2014 and May 2016.

The study was conducted in six treatment institutions in three countries – Denmark (Copenhagen, Aarhus, and Odense), Germany (Munich and Dresden), and the United States (Albuquerque, New Mexico) – and consisted of 693 patients aged 60 or older.

Patients underwent treatment for alcohol use disorder through a conversation-based rehabilitation method called motivational enhancement therapy aimed at boosting enthusiasm levels for behaviour change and promoting engagement in the process.

The patients completed questionnaires at the beginning of treatment and were followed up at four and 12 weeks, six months and a year.

Information on sociodemographic factors, alcohol consumption, quality of life, and more was collected during the follow-ups.

Tryggedsson said: “At times, achieving complete abstinence isn’t realistic, especially for patients dependent on alcohol. Even starting from a high point, a reduction yields a significant effect. Both the treatment process and the post-treatment period are pivotal.”

He believes the results can serve to enlighten therapists and physicians, highlighting the importance of encouraging older adults with alcohol use disorder to seek treatment.

“When they observe signs of alcohol-related issues in patients, they should address it without hesitation and confront potential abuse. In doing so, they are providing a valuable service to the patients, even if the patients may not recognise it as such,” Tryggedsson stated.

For decades the public has been confronted with conflicting research-led advice when it comes to alcohol intake. Too much alcohol is bad for you; a little does you no harm; red wine is better than white; the occasional binge will help keep your spirits up (no pun intended).

But in January 2023, the World Health Organisation published a statement in The Lancet Public Health saying that when it comes to alcohol consumption, there is no safe amount that doesn’t affect health.

Much of the focus has been on trying to encourage young people to avoid alcohol, however, with little effort directed at the older age group. It was this that Tryggedsson said first encouraged him to conduct a study specifically aimed at older adults and alcohol abuse.

“In Denmark, there is a lot of focus on the problematic alcohol use in our younger age groups. It is often said that Danish young people, down to 15-year-olds, are the European champions of being intoxicated and binge drinking. A record you can’t be very proud of from a public health perspective,” he expounded.

“There are lots of reasons to focus on problematic alcohol use during childhood and adolescence – binge drinking being one of them. However, when looking into which age groups exceed Danish National guidelines of no more than 10 drinks per week, the highest proportions are seen within men aged 65-74 years old (32.5%).

“Among men, two other age groups exceed the proportion seen among the 16-24 year-olds (23.9%), that is the 55-64 year-olds and the plus 75 year olds (27.1% and 29.9%, respectively).

“Among women, the highest proportions are seen among the 16-24 year-olds and the 65-74 year-olds (14.0% and 13.7%, respectively).

“Thus, older Danish adults, especially men, make up the largest proportion of people who exceed Danish National guidelines of no more than 10 drinks per week.

“Furthermore, these numbers are not decreasing over time at the same rate in the older age groups as among the younger ones.

“As my colleagues had recently performed a study, comparing two psychosocial interventions aimed at treating alcohol use disorder in older adults (60-plus years), I was able to use their data to investigate gender differences in an older population of alcohol use disorder patients, an area of interest that arose when looking at the Danish numbers.”

Most noticeable were gender differences in drinking patterns, which seemed to be particularly pronounced among older adults. Tryggedsson said: “Older men are reported to drink more often and in higher quantities than older women, resulting in higher rates of hospitalisation and more deaths in men.

“Furthermore, binge drinking, which leads to the greatest level of harm, is much more frequent among older men than women. Overall, it is estimated that the number of older adults suffering from AUD is higher in men than in women.”

But Tryggedsson noted: “In recent years, however, the gender gap in alcohol use has been reduced, mainly due to older women drinking more often and in higher quantities, including binge drinking.”

There are several reasons as to why gender differences exist in alcohol use, especially in older populations, Tryggedsson told Agetech World. “Older adults may experience widowhood, living alone, retirement, and a dwindling social network. Specifically, older women have been found to be more frequently widowed, living alone, and showing higher rates of retirement compared to older men. Thus, gender potentially interacts with other factors, and often with several at a time.”

Given his study has shown that older adults dealing with alcohol use disorder can be helped towards a better quality of life, why does Tryggedsson think that within the medical profession helping this age group has traditionally been seen as a ‘lost cause.’

“There are several possible reasons for this. Older adults may be less likely to disclose a history of excessive alcohol use. Also, the presentation of excessive alcohol use in older adults may be atypical, such as falls, confusion, and depression, and masked by comorbid physical or psychiatric illness, which makes detection all the more difficult.

“Thus, healthcare workers might have a lower degree of suspicion when assessing older people. Healthcare workers may also perceive alcohol use disorders in older people as being understandable in the context of poor health and changing life circumstances.

“Lastly, national guidelines on alcohol consumption may not apply to older people because of age-related changes in metabolism, advancing ill health, and increased sensitivity to the effects of alcohol.

“All of these factors are likely to result in under-detection and misdiagnosis of alcohol use disorder in older adults, among other things, by giving false impressions of the true extent of the problem.”

With governments across the globe facing a ticking timebomb when it comes to funding the care needs of their ageing populations, a leading social and medical anthropologist has told the latest Agetech World podcast that there is much Japan can teach policymakers.

Click here to listen to the latest Agetech World podcast

Among Dr Iza Kavedžija’s main research interests is exploring the lived experience of ageing in urban Japan.

The Assistant Professor of Medical Anthropology in Cambridge University’s Department of Social Anthropology has lived in Japan and conducted extensive ethnographic fieldwork with two distinct groups of people in the Kansai region.

This led to her first in-depth study, Making Meaningful Lives: Tales from an Ageing Japan, and has underpinned a series of journal articles addressing a broad range of topics including care, hope and hopelessness, and happiness and gratitude.

In conversation with Agetech World, Dr Kavedžija said Japan had long been known for its widespread respect for the older population and its sense of obligation to caring for them.

The country has one of the world’s oldest populations, with nearly 30% of its 125m inhabitants aged over 65. This age group is expected to account for 34.8% of the populace by 2040.

Whilst this is inevitably putting a strain on Japan’s long-term care system, the country’s politicians and wider society are continuing to learn, evolve, and devise radical solutions to meeting this growing demographic challenge.

Japan has always had a strong tradition of family caring for its older citizens. But to this has been added a Long-Term Care Insurance (LCT) scheme, a complete package for the over-65s covering both the financing and the implementation of social care according to needs, supported by mandatory premiums levied on those aged 40-plus and co-payments from users.

Further responding to the nation’s ageing society, Japan is preparing to introduce a new Community-based Integrated Care System by 2025, with the aim of ensuring the comprehensive provision of health and nursing care, housing, and livelihood support.

Japan has also been working on developing robots to automate care for older adults, and other innovations include government investment in non-medical activities that can help prevent age-related illnesses; helping the over-65s flourish by working with them in their homes and communities rather than expecting them to conform to current societal norms or live in neglect; and making their towns and cities easier to navigate so seniors can still participate in everyday life whether for pleasure or work.

The number of residential homes is restricted with the emphasis on community care

Dr Iza Kavedžija

Asked what Japan can teach the likes of the UK – which is facing a soaring health and care crisis – Dr Kavedžijan said: “I think there are many things that Japan has paid close attention to.

“I think the Long-Term Care Insurance is one of a kind… that allows for the drawing on services from various sectors, so it is possible to create a mix of forms of support, whether it be home care, whether it be various forms of assisted living…so a lot of interventions that are in the community and a lot of providers that range from non-governmental to the state sector to the private sector, where one can create a plan of care and support with a care manager that’s tailored to the needs (of the individual) drawing from the broad range of services.

“It isn’t always the same sort of story where the plan has led towards institutional living.

“In this sense I think Japan has been particularly successful. Of course, as the proportion of older people is so high in the population, this system is somewhat coming under strain. I don’t want to represent it as a particularly rosy situation. It isn’t. There are challenges to it.

“But I think nonetheless that this very, very well thought out system of support is important and it also cultivates these various forms of dependence, or interdependence, where one can draw on different types of assistance.”

Dr Kavedžija added: “It actually also allows people to continue living relatively independent lives….it doesn’t necessarily mean they have to move in with their children.

“So, they think of older people as the ones who continue the tradition and social changes as something that is brought on by younger people.

“In this case, I think we have seen very clearly that it is older people themselves that have often been the active leaders in social change. They have been the ones often saying, ‘I know there is an expectation for me to depend on my older son, but I don’t want to be a burden on my children.’

“So, they cultivate various forms of care in the community and they themselves become very involved in a huge range of activities, volunteer activities, that foster support in the community and create these communities of care.

“That is, I think another lesson that would translate well elsewhere.”

But Dr Kavedžijan also gave a note of caution. “I don’t want to paint too much of a positive picture because certainly challenges are there. That is something that again is perhaps an important lesson, and that is to do with the circulation of care, as I like to call it, where we need to think of care in systemic ways.

“For instance, elder care largely depends on a volunteer workforce, and that had for many years often consisted of women.

“In order to support better care for elders I think it is necessary to consider in which ways we can perhaps support childcare. So, to think about these flows of care in a much broader way and try and foster support across the board rather than thinking of them as separate units…that are not intertwined.”

The project aims to identify people at risk of dementia before symptoms appear.

More than 7 million people are living with dementia in the EU. This number is projected to double, reaching 14 million by 2050.

There is currently no cure for Alzheimer’s disease. Although the search for potential treatments is showing promise, it is anticipated that these medications will be most effective in the early stages of the disease.

The recently launched AI screening platform, PREDICTOM aims to identify individuals at risk of developing dementia, even before symptoms manifest.

The cognitive and biomarker screening platform has this week announced it will be backed by €21 million in funding, with €8 million from the EU, €9 million from industry and €4 million from UKRI.

A consortium of 30 partners from academia, business, civil society and hospitals is steering the project. The Consortium includes partners from 15 countries across Europe, Asia and America and is led by Stavanger University Hospital.

Dag Aarsland, Professor of Old Age Psychiatry at King’s College London and research lead at Stavanger University Hospital, is the leading the project.

“Detecting early signs of dementia is key to slowing its progression. Unfortunately, a majority of those at risk are not identified in time. Our platform seeks to change this by enabling early discovery, allowing timely intervention and preventative treatment,” Aarsland said.

A crucial aspect of PREDICTOM is that much of the screening can be performed by the patients themselves in the comfort of their homes.

By initiating the process at home, the project aims to reduce strain on healthcare services and associated costs. Biomarkers, including saliva, stool, digital markers and blood via prick-tests, will be collected at participants’ homes or GP offices, streamlining a process traditionally carried out in hospitals or specialised clinics.

More than 4000 participants will partake in PREDICTOM’s trial project. The samples will be based on a pool of people from previous initiatives like PROTECT UK, PROTECT Norway and Radar-AD, as well as people from the catchment area of other participating centres in Germany, France, Switzerland, Belgium and Spain.

“If our project succeeds, there will be significant savings in both cost and time,” Aarsland said

After the home collection, samples will be sent to PREDICTOM, where their platform will process the participant data, integrating blood, cerebrospinal fluid, imaging, electrophysiological and digital biomarkers.

AI algorithms will generate risk assessments, early diagnoses and prognoses, laying the foundation for early intervention and treatment.

This project is part of the Innovative Health Initiative (IHI), a public-private partnership (PPP) between the European Union and the European life science industries.

“We are very pleased to have such a robust team with top notch expertise spanning diverse fields, including IT, AI, medicine, ageing research and professionals from both small and large businesses,” Aarsland added.

The project runs from 1st November 2023 to 31st October 2027.