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New research shows it’s never too late to tackle alcohol abuse

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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.”

Wellness

Music may have health benefits for older adults, finds poll

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From stress relief and improved mood to keeping minds sharp and connecting to others, a poll of people aged 50 to 80 finds many positives from listening to or making music.

Whether it’s singing in a choir, playing the living room piano, joining in hymns at church, or just whistling along with the radio, a new poll finds that nearly all older adults say music brings them far more than just entertainment.

Three-quarters of people age 50 to 80 say music helps them relieve stress or relax and 65 per cent say it helps their mental health or mood, according to the new results from the University of Michigan National Poll on Healthy Aging. Meanwhile, 60 per cent say they get energised or motivated by music.

Those are just a few of the health-related benefits cited by older adults who answered questions about listening to and making music of all kinds.

Virtually all (98 per cent) said they benefit in at least one health-related way from engaging with music. In addition, 41 per cent say music is very important to them, with another 48 per cent saying it’s somewhat important.

“Music has the power to bring joy and meaning to life. It is woven into the very fabric of existence for all of humankind,” said Joel Howell, M.D., Ph.D., a professor of internal medicine at the U-M Medical School who worked with the poll team.

Music also has tangible effects on a variety of health-related ailments, he adds. “We know that music is associated with positive effects on measures from blood pressure to depression.”

The poll is based at the U-M Institute for Healthcare Policy and Innovation and supported by AARP and Michigan Medicine, the University of Michigan’s academic medical centre. The poll team asked a national sample of adults aged 50 to 80 about their experiences with and feelings toward listening to and making music.

Many older adults reported making music with other people at least occasionally, whether by singing or playing an instrument. In all, eight per cent said they have sung in a choir or other organised group at least a few times in the past year. About eight per cent of all older adults said they play an instrument with other people at least occasionally.

In all, 46 per cent of older adults reported singing at least a few times a week, and 17 per cent said they play a musical instrument at least a few times a year.

Most respondents reported listening to music, with 85 per cent saying they listen to it at least a few times a week, 80 per cent saying they’ve watched musical performances on television or the internet at least a few times in the past year, and 41 per cent saying they had attended live musical performances in person at least a few times in the past year. That latter percentage was higher among those with higher incomes and more education.

The poll shows other differences between groups in music listening habits and health impacts.

Those who said their physical health is fair or poor, and those who say they often feel isolated, were less likely to listen to music every day. Black older adults were more likely than others to have sung in a choir in the past year, and Black and Hispanic older adults were more likely to say that music is very important to them.

“While music doesn’t come up often in older adults’ visits with their usual care providers, perhaps it should,” said poll director Jeffrey Kullgren, M.D., M.P.H., M.S.

“The power of music to connect us, improve mood and energy, or even ease pain (like 7% of respondents said it does for them), means it could be a powerful tool.” Kullgren is a primary care physician at the VA Ann Arbor Healthcare System and associate professor of internal medicine at U-M.

Howell notes that music helps people keep in touch with one another throughout their lifetime. Indeed, 19 per cent of the poll respondents said music is even more important to them now than it was in their youth, and 46 per cent said it’s just as important to them now as then.

With the rising concern about the health effects of loneliness and social isolation among Americans in general, and especially among older adults, the power of music to connect people and support healthy aging should not be underestimated, Howell says. The NPHA has previously reported on trends in loneliness and social isolation in older adults.

“Music is a universal language that has powerful potential to improve wellbeing,” said Sarah Lenz Lock, senior vice president of Policy and Brain Health at AARP and executive director of the Global Council on Brain Health.

“AARP’s own research shows that music can play an important role in healthy aging by improving our moods, fostering social connections and, potentially, enriching our brain health.”

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Wellness

Playing an instrument linked to better brain health in older adults – study

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Engaging in music throughout your life is associated with better brain health in older age, according to a new study published by experts at the University of Exeter.

Scientists working on PROTECT, an online study open to people aged 40 and over, reviewed data from more than a thousand adults over the age of 40 to see the effect of playing a musical instrument – or singing in a choir – on brain health.
This study is supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration South West Peninsula (PenARC) and NIHR Exeter Biomedical Research Centre.
Over 25000 people have signed up for the PROTECT study, which has been running for 10 years. The team reviewed participants’ musical experience and lifetime exposure to music, alongside results of cognitive testing, to determine whether musicality helps to keep the brain sharp in later life.
The findings show that playing a musical instrument, particularly the piano, is linked to improved memory and the ability to solve complex tasks – known as executive function. Continuing to play into later life provides even greater benefit.
The work also suggests that singing was also linked to better brain health, although this may also be due to the social factors of being part of a choir or group.
Anne Corbett, Professor of Dementia Research at the University of Exeter said: “A number of studies have looked at the effect of music on brain health. Our PROTECT study has given us a unique opportunity to explore the relationship between cognitive performance and music in a large cohort of older adults. Overall, we think that being musical could be a way of harnessing the brain’s agility and resilience, known as cognitive reserve.
“Although more research is needed to investigate this relationship, our findings indicate that promoting musical education would be a valuable part of public health initiatives to promote a protective lifestyle for brain health, as would encouraging older adults to return to music in later life. There is considerable evidence for the benefit of music group activities for individuals with dementia, and this approach could be extended as part of a healthy ageing package for older adults to enable them to proactively reduce their risk and to promote brain health.”
Stuart Douglas, a 78-year-old accordion player from Cornwall, has played the instrument throughout his life and now plays with the Cober Valley Accordion Band as well as the Cornish Division of the Royal Scottish Country Dance Society.
He said: “I learnt to play the accordion as a boy living in a mining village in Fife and carried on throughout my career in the police force and beyond. These days I still play regularly, and playing in the band also keeps my calendar full, as we often perform in public. We regularly play at memory cafes so have seen the effect that our music has on people with memory loss, and as older musicians ourselves we have no doubt that continuing with music into older age has played an important role in keeping our brains healthy.”
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Research

Smart wristband developed to identify and manage atrial fibrillation

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It’s one of the most common conditions affecting those over 65 and left untreated can lead to stroke, blood clots in the veins and, in the most extreme cases, heart failure.

Atrial fibrillation currently affects more than 40 million people worldwide and the incidence and prevalence of the medical condition have increased three-fold in the past 50 years as populations age and survival rates for chronic diseases increase.

Now thought of as a global epidemic, 16 million people in the United States alone are projected to have been diagnosed with the ailment by 2050. In Europe, the figure among the over 55s is expected to reach 14 million by 2060.

It is estimated that by 2050, AF will be diagnosed in at least 72 million individuals in Asia.

One of the most common symptoms of AF is a pounding, fluttering, or quivering heartbeat, more commonly known as heart palpitations. Other signs include dizziness, fatigue, a fast heart rate of more than 100 beats per minute, breathlessness, and chest pain – many of the classic stress or anxiety signs that characterise a panic attack.

It’s one of the reasons that millions of people are walking around unaware that they are suffering from atrial fibrillation. How many times have you heard someone attribute their racing heartbeat to a caffeine-induced surge brought about by having drunk one too many coffees?

Many more are asymptomatic, meaning they are producing and showing no symptoms at all.

Often the condition will only be picked up when a patient undergoes a health check for an unrelated matter.

However, early detection and treatment of AF are paramount if later complications are to be avoided.

Without treatment, people with AF are up to five times more likely to suffer strokes, leading to the risk of severe disability and even premature death.

But new patient-safe monitoring technology to check and manage individual factors provoking atrial fibrillation, has been invented by Lithuanian researchers that could hold the key to earlier diagnosis and outcomes for the potentially serious heart condition.

A smart wrist-worn bracelet has been developed by Lithuanian scientists to identify atrial fibrillation. Credit: KTU

It involves patients wearing a so-called smart bracelet – already an accepted accessory for many – that uses an algorithm that can detect atrial fibrillation.

Traditional methods of diagnosing AF involve patients having to wear intrusive and uncomfortable sensors. But this new technology incorporates complementary sensors and a signal processing algorithm, with patients also being asked to input potential arrhythmia triggers on a mobile app.

The device is the result of a successful collaboration between the Kaunas University of Technology Biomedical Engineering Institute (KTU BMEI) and Vilnius University’s Santaros Clinics.

Researchers at KTU BMEI have been working in the field of atrial fibrillation monitoring technology development for more than a decade. It was several years ago that they developed the bracelet – the patent application for the device was submitted to the Lithuanian State Patent Bureau at the end of 2018 – which is aimed at older people, who can be especially self-conscious when using technologies and smart devices.

Professor Vaidotas Marozas, director of KTU BMEI, told Agetech World: “We are focusing on developing technologies which are needed for the public and contemporary medicine. For example, due to the prevalence of this condition (AF), every person older than 65 should be checked for atrial fibrillation.

“Non-invasive, compact wearable devices are an attractive solution for monitoring the health status of such high-risk groups.”

The disease usually starts with self-terminating so-called ‘paroxysmal episodes’ which, if recognised in time, can be treated by non-medication means.

These episodes may be different for each patient, however. For some, they may last for a short time and recur infrequently. For others, the episodes can be longer and more frequent.

But untreated AF will eventually develop into a persistent condition, which is more complicated to treat.

The smart wristband developed by Lithuanian scientists. Credit: KTU

The KTU-developed smart bracelet – which Lithuanian company, Teltonika, has stepped in to produce – has been used together with other devices in the TriggersAF project supported by the European Regional Development Fund.

The aim of the project coordinated by the Kaunas University of Technology in partnership with Vilnius University, is to develop and test methods that allow patients to identify their individual arrhythmia triggers via a wrist-wearing device.

It is already known that for some patients, atrial fibrillation episodes can be provoked by certain modifiable factors, such as alcohol, increased physical activity, stress, and sleep disturbance.

Identifying and avoiding individual factors would help determine non-pharmaceutical intervention methods to arrhythmia management.

As the project addresses a clinical problem, it has been important to have on board experienced clinicians who deal with AF daily. One of them is Justinas Bacevičius, a cardiologist at VU Hospital Santaros Clinics.

He said: “Although we see a wide variety of atrial fibrillation patients in our hospital, two types can be distinguished. The first group includes older, overweight, diabetic, hypertensive patients or those having sleep apnoea.

“The second group is the complete opposite – often they are young, professional sportspersons, businesspeople or performers who are experiencing a lot of stress.”

Mr Bacevičius said the data from the patients suggests a link between the onset of arrhythmia and sleep disorders.

He added that interestingly, even in patients who are not diagnosed with sleep apnoea, a correlation between snoring during sleep and the onset of atrial fibrillation in the morning, or later in the day, had been identified.

But with no objective methods to identify individual factors influencing the arrythmia in patients, KTU BMEI researchers in collaboration with cardiologists from VU Hospital Santara Clinics and their long-term partner Leif Sörnmo from Lund University in Sweden, have proposed one.

It assumes that arrythmia parameters, such as the relative duration of an episode, increase after an arrythmia-provoking factor.

Vilma Pluščiauskaitė, a PhD student at KTU and a junior researcher on the project, explained: “The essence of our proposed approach is that the patient uses a wearable bio signal-recording device for a set monitoring period, e.g. two weeks, and enters potential triggers for atrial fibrillation into a mobile app.

“For the next two weeks, the patient avoids the identified potential triggers, and the relation is assessed by an equation proposed by KTU BMEI researcher Dr Andrius Petrėnas.

“If a correlation between the influencing factor and the occurrence of arrhythmia is detected, the patient is advised to avoid the specific identified factor.”

The project’s database is the first of its kind in the world. It includes the recorded patients’ physiological signals, such as electrocardiogram and photoplethysmogram (a simple and low-cost technique that sends light pulses through the skin into the blood vessels to detect blood volume changes), and potential arrythmia provoking factors entered in a person’s mobile app.

The database collected by the researchers has allowed them to test the developed method and identify arrythmia-provoking factors in individual patients.

Professor Vaidotas Marozas. Credit: KTU

Project leader, Professor Marozas, is understandably delighted with its success, which will allow further development of the smart bracelet technology.

He said: “The database generated by the project is a unique result. We have managed to interest an international consortium funded by the European Metrology Association in this data. This consortium has invited us to join their new project as a partner and we will continue our work.”

The lack of technology currently available to individually identify arrythmia-provoking factors is probably due to the fact that monitoring has traditionally been inconvenient. Patients usually have to have an electrocardiogram (ECG), which is an electrical recording of their heart rhythm.

If that doesn’t identify a problem, then further monitoring will be needed, involving having to wear a portable ECG recording device for 24 hours or more.

Patients may also be required to fill in numerous questionnaires to pinpoint trigger factors, which can be subject to recall bias, where they either forget about a potential arrhythmia provoking stimulus or are reluctant to acknowledge the presence of certain influences, such as alcohol intake.

Mr Pluščiauskaitė said: “Certain influencing factors for arrythmia, such as increased exercise, stress, or sleep disturbances, can be identified from physiological signals by the dedicated algorithms. However, other influencing factors, such as alcohol consumption, are difficult to identify in the signals, so it is best if the patient has the opportunity to indicate when he or she consumed alcohol.”

He added that it is hoped that in the future, identifying these arrythmia triggers will only require a smart bracelet incorporating complementary sensors and signal processing algorithm.

 

 

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