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This blog was written by Dr. Roxanne Armstrong-Moore, Postdoctoral Research Associate MRC Epidemiology Unit, University of Cambridge; and Dr. Rahul (Tony) Rao, Consultant and Visiting Lecturer in Old Age Psychiatry, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience.
Alcohol is a major risk factor globally and is the seventh leading risk factor for both deaths and disability adjusted life years (DALYs) (GBD 2016 Alcohol Collaborators, 2018). Furthermore, with direct relevance to the COVID-19 outbreak, alcohol abuse can suppress the immune system; which is associated with an increased risk of infection (Molina et al., 2010). Older individuals are now the age group at highest risk of rising alcohol misuse (Office for National Statistics, 2017). A potential reason for this is as a response to the stress from a culmination of factors that are unique to old age, such as changes in finances, social isolation, lack of purpose and lack of routine. (Kuerbis & Sacco, 2012). These factors are synonymous with those that individuals are likely to feel during the COVID-19 outbreak (Brooks et al., 2020).
Social isolation and loneliness contribute to an increase in all-cause mortality in older people (Perissinotto et al., 2012) with suggestions that whilst both isolation and loneliness can impede an individual’s quality of life, efforts to reduce isolation are likely to be more relevant in reducing mortality (Steptoe et al., 2013) . Social isolation and loneliness are cited as reasons for an increase in alcohol use in older individuals (Kelly et al., 2018). We must learn from this research on the conditions which are ordinarily unique to older individuals and make an attempt to apply such findings to the general population, whilst they share similar conditions in such times.
Along with social isolation, lack of purpose and lack of routine are also key factors that may serve as “risk” factors for increasing alcohol use in older individuals and likewise during the COVID-19 outbreak. These risk factors can be linked to not having a meaningful role within society. Successful ageing has often relied on self-development that is outside the work setting, examples of these could include learning new skills, volunteering or taking part in other social activities beyond the workplace (Heaven et al., 2013). However, with social distancing constraints in place, this proves difficult and may also worsen feelings of social isolation and loneliness. Suggestions from the UK government include home exercise, taking part in activities that provide enjoyment and staying in close contact with friends and family (Gov.uk, 2020) . Individuals could make use of the online communities that are increasingly popular and will serve to validate meaningful social roles and will partly contribute to an avoidance of feeling socially isolated.
During retirement, individuals experience specific stressors. They can lose roles that existed in their working lives that provided them with a sense of purpose and social contact (Heaven et al.). Similarly, during the COVID-19 outbreak, individuals are working differently (i.e. from home) or have lost their jobs altogether. Economic crises have been shown to widen health inequalities and to increase alcohol use (de Goeij et al., 2015). Implementing new roles and therefore solidifying an individual’s feeling of identity could lead to an improvement in general wellbeing and less inclination to turn to alcohol as a coping mechanism, such new roles could come from volunteering with those who are more vulnerable or committing to a temporary role in the meantime that could provide some a level of financial remuneration (where individuals are both physically and mentally able to do so).
Routine is evidently an important factor of wellbeing in individuals, and a lack of such in retirement can lead to poor mental health and thus serve as another risk factor for alcohol use. Individuals who continue to work during retirement express that they do so in order to maintain their sense of routine (Sewdas et al., 2017) . Individual’s routines are sacrificed during this outbreak and the solution for this is, as government guidelines suggest (Gov.uk, 2020) – is to keep a routine, despite your situation.
Individuals across the world are experiencing a change in their finances and similarly, this is outlined as a key stressor for those in retirement (Barbosa et al., 2016). To avoid an influx in stress-related alcohol use and a widening in inequalities the only appropriate suggestion would be that governments worldwide continue to support and advise individuals during this time, and offer appropriate financial recompense to assure households and families that they will not suffer unduly, based on their financial situation during this crisis.
Social interaction, is a key part of daily life and not enjoying such interaction, as well as experiencing other psychosocial factors such as financial strain, lack of routine or purpose and social isolation puts individuals at a higher of alcohol misuse (Royal College of Psychiatrists, 2018). The similarities between an increase in alcohol use in older people, and the conditions faced in lockdown during the COVID-19 outbreak are striking. Without due care and attention from the government and the public, we risk increased burden on health services beyond the global pandemic.
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Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. In The Lancet. https://doi.org/10.1016/S0140-6736(20)30460-8
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Steptoe, A., Shankar, A., Demakakos, P., & Wardle, J. (2013). Social isolation, loneliness, and all-cause mortality in older men and women. Proceedings of the National Academy of Sciences of the United States of America. https://doi.org/10.1073/pnas.1219686110