In this guest blog, Dr Paulina Trevena, from Glasgow Caledonian University, explores older adults’ experiences of using alcohol services during the COVID-19 pandemic, with a particular focus on Scotland.
The blog is based on recent UK-wide qualitative research by a team from Glasgow Caledonian University and the University of Bedfordshire. The study involved seven alcohol voluntary treatment services providing support in urban and rural areas of England, Wales, Northern Ireland and Scotland and their service users aged 55+. We interviewed 15 service providers and 30 service users. In Scotland, all interviewees were employees or users of the same voluntary organisation delivering support across the country.
As with all guest blogs, what follows are the views of the authors, not those of SPICe or indeed the Scottish Parliament.
An opinion poll for We Are With You, a UK-wide alcohol charity, found that 51% of over 50s in the UK were drinking above healthy limits during lockdown. Qualitative research seeks to understand why this is happening and how older adults with alcohol problems feel they are supported under Covid-19 restrictions.
Usually, alcohol service users receive treatment face-to-face through individual meetings with their recovery workers and/or attending peer support group meetings. Following the announcement of a national lockdown in March 2020, alcohol services moved to providing support remotely, over the phone and online. In Scotland, limited face-to-face support is available, and only for the most vulnerable people.
Background – Older people, alcohol, and the pandemic
COVID-19 has had a mixed impact on people’s drinking levels with similar proportions of people reporting either drinking the same or less, or drinking more. Evidence indicates that those who had been drinking most frequently have also increased their alcohol consumption most. There has also been an increase in the prevalence of high-risk drinking, that is 14-35 units a week for women and 21-50 units a week for men. .
Among people aged 50+ in the UK, almost one in four can currently be classed as a high-risk or dependent drinker. As people age, the impact of alcohol on health becomes more serious. Older people who drink at harmful levels are more likely to develop alcohol-related conditions, such as coronary heart disease, strokes, liver problems or certain types of cancer. They also tend to suffer more alcohol-related falls and accidents. They take more medication, and mixing it with alcohol increases the risk of detrimental side-effects.
Older people are also more vulnerable to the wider effects of the pandemic. They tend to be more isolated and sometimes fall through the support net. For instance, one older lady we interviewed was too frightened to do her own shopping at the onset of lockdown which eventually led to hospitalisation due to malnutrition. Older adults also have more underlying health conditions and are at increased risk of harm from COVID-19 compared with other age groups, and especially those aged 75+.
Providing adequate support to older people during the pandemic has been recognised by the World Health Organisation as a serious public health issue.
Our study results
You can read the full study Addressing the needs of older adults receiving alcohol treatment during the Covid-19 pandemic: A qualitative study.
Providing practical support in Scotland
In Scotland, age is a protected characteristic under Equalities legislation. This is reflected in guidelines for Scottish alcohol services under Covid-19 and the approach demonstrated by local services. Uniquely in Scotland, the alcohol service (along with other public and voluntary sector services) provided high levels of practical support in the wake of lockdown. This included delivering food parcels and helping recipients manage essential bills, for example.
The alcohol service in Scotland adopted a person-centred approach aiming to address issues of isolation and meet individual needs as far as possible. However, providing hands-on support is much more difficult in rural-remote areas where travel is a considerable challenge. As one rural alcohol service provider explained, it could take them up to two and a half hours each way to travel to a service user. The alcohol service in a rural-remote area of Scotland thus worked in partnership with other support agencies, rather than provide practical support directly.
Can older people use alcohol services online?
Under lockdown, alcohol services are providing a lot of support online, including one-to-one appointments, drop-ins, and peer support group meetings. Additionally, some offer online activities such as yoga, mindfulness, dance, or arts and crafts workshops. However, older people face various barriers to accessing online support. Many do not have modern technology (such as mobile phones, laptops or computers), do not know how to use it, or do not have internet access.
Compared with other parts of the UK, older service users in Scotland appeared more disadvantaged in this respect. For instance, one man was using a 26-year-old mobile phone for communication. Another only had limited internet access via his phone. While digital literacy among older people was a general issue across the UK, access to technology seemed a distinct barrier in Scotland, and especially in rural areas. Scottish service providers mentioned trying to source technology or arranging for internet access to support their most deprived service users.
For some older people, accessing peer support groups online was also difficult due to confidentiality concerns. For example, one man, who had become homeless during the pandemic, was staying in a shelter, where he had no privacy. Confidentiality issues, along with stigma and shame, can act as a barrier to accessing group work (online of offline) especially in tight-knit rural communities.
Despite the broad variety of activities offered by Scottish alcohol services online, these were not commonly used by older service recipients. Many were receiving support over the phone only, and were hence missing out on accessing peer support groups and other activities online.
Is alcohol support over the phone adequate for older people?
Older people generally appreciated receiving phone support during the pandemic. It was especially valued by service recipients who were striving to maintain abstinence or lower levels of drinking. They felt their alcohol workers were highly approachable and “always there” when they needed them, and that they might have relapsed otherwise.
However, support over the phone is not adequate for everyone. It largely excludes older people who have memory, speech or hearing impediments, or serious mental health issues. For example, one recovery worker was supporting an older man who had a severe speech impairment following a stroke. Communication over the phone was very difficult, and providing online support was not possible. When this eventually became feasible, they started doing socially distanced walks which greatly helped communication.
Support over the phone was also seen as insufficient for those drinking heavily. Recovery workers believed a face-to-face intervention was essential in such cases.
Why face-to-face contact is crucial
Under the current restrictions due to Covid-19, alcohol services in Scotland and the UK provide most support for older people over the phone and online. However, older people face barriers to using remote support, especially online support. Most express a clear preference and need for face-to-face contact.
Face-to-face contact is important for a number of reasons. It helps combat loneliness, a frequent reason behind drinking in older age. It facilitates better understanding of alcohol interventions. In the case of those with memory, speech or hearing impairments, face-to-face contact is crucial. The same is true for older people with serious mental health issues, or in a particularly vulnerable state. Covid-19 is thus greatly impacting on alcohol services’ ability to fully meet the needs of their older recipients.
Phone support cannot substitute face-to-face contact. However, mixing face-to-face and remote support might be beneficial under some circumstances, for instance in rural-remote areas where travel is an issue for both service providers and recipients.
To better support older adults struggling with alcohol use during the pandemic, the charity We Are With You have launched a new helpline for over 50s.
Dr Paulina Trevena, Glasgow Caledonian University