Why do some older adults start drinking excessively late in life? Results from an Interpretative Phenomenological Study

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Excerpt

Alcohol problems among older adults (60+ years) are under‐recognised. However, interest in alcohol problems among the elderly is increasing, especially as statistics suggests that this population will be growing in the coming decades 1.
A particularly interesting subgroup is older adults who experience very late‐onset alcohol use disorders (AUD) 6, defined as the onset of AUD after the age of 60. Research indicates that approx. 11–16% of all older adults with AUD are very late‐onset (VLO) individuals 7. Individuals experiencing VLO AUD differ significantly from early‐onset AUD individuals in their capacity to control drinking behaviour, desire/compulsion to drink alcohol and physiological withdrawal symptoms. VLO AUD individuals also tend to have a higher level of education, income, life satisfaction and stability of residence 8. Liberto and Oslin 10 found that because they experience fewer bio‐psycho‐social problems, individuals with VLO AUD are less self‐critical of their drinking and more likely to deny their alcohol problems than early‐onset AUD individuals. They also found that VLO individuals tend to present fewer mature defence reactions and have less social support than early‐onset individuals, which is aetiologically linked to late‐life social stressors.
Research on the reasons why some people develop ADU very late in life is scarce 3, and the few studies available draw different, even opposing, conclusions.
In general, a number of different factors seem to influence VLO AUD; among them are chronic stress7, late‐life stress, health issues8, friends' approval of drinking12, loss of role or work identity, 16, negative life events23, a history of alcohol use/abuse25, loneliness26, level of anxiety27, pleasure28, more time and money available, alcohol used as a response to pain, enhancing social experience and relaxation29 and being male25. Less common findings on causes for VLO AUD include family enabling31 and familial alcohol problems32.
In a review of retirement and its influence on VLO AUD, Kuerbis and Sacco 34 found that in particular social network, time, demands from workplace, income and roles or work identity seemed to have an influence on late‐onset AUD. They also found that retirement itself had ‘…little or no direct effect on drinking behavior or alcohol problems…’ (p. 593); it seemed that alcohol consumption declined with retirement. They found that preretirement conditions like high job satisfaction, or high workplace stress, increased the overall use of alcohol (including problematic use). Whether retirement was voluntary or involuntary also seemed to have some impact on drinking behaviour after retirement. However, these findings were opposite to earlier findings by Ekerdt et al. 35 who concluded that over a 2‐year follow‐up, retirement was not associated with change in alcohol consumption. Only a minor short‐term effect of retirement on alcohol consumption was found, suggesting that retirement, in and of itself, is not necessarily a factor in late‐onset alcohol use disorder.
Since research points in multiple directions, it is imperative that we further investigate the population of older adults with very late‐onset AUD, in order to be able to develop specialised treatment and preventive efforts to decrease health‐related costs and remission rates. There is a lack of a unified theory, just as only a limited number of qualitative investigations have been performed. The present qualitative study is designed to increase the understanding of why some older adults start drinking excessively late in life.
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