The epidemiology and associated burden of potentially serious alcohol-medication interactions in ageing populations in Ireland and the UK
Dr G Cousins
Monday, December 02, 2019
Competition Funded PhD Project (Students Worldwide)
How the body handles alcohol changes as we get older. Ageing lowers the body’s tolerance for alcohol; alcohol circulates in an older person’s body for a longer time and the effects of drinking last longer. Even at relatively low levels of alcohol consumption, older adults are vulnerable to alcohol-related harms, with exposure to multiple medications exacerbating these harms, due to changes in absorption, distribution and metabolism of alcohol and other medications with age. Alcohol-medication interactions may increase the risk of hypoglycaemia, hypotension, sedation, gastro-intestinal bleeding and liver damage. We recently developed the POSAMINO criteria (POtentially Serious Alcohol-Medication Interactions in Older adults), an explicit set of 38 potentially serious alcohol-medication interactions in older adults.
Our preliminary analyses suggest that almost one in five older adults are at risk of potentially serious drug-alcohol interactions, with exposure to POSAMINO criteria involving central nervous system agents, associated with an elevated risk of falls and injurious falls. Given that older adults are often reluctant to reveal a history of excessive alcohol consumption, and healthcare professionals have a lower degree of suspicion when assessing older adults, the question of risk arising from a patient’s alcohol consumption may never arise in a consultation.
The POSAMINO criteria may be useful in a clinical setting to risk stratify patients at the point of prescribing, allowing for the identification of patients whose alcohol consumption places them at increased risk and who would benefit from a brief intervention. However, prior to informing clinical or public health initiatives, the POSAMINO criteria require further validation, in national and international longitudinal studies, to prospectively quantify the magnitude of risk posed for major health outcomes. The proposed study plans to harness the rich longitudinal information on alcohol consumption and co-occurring medication use among older adults in Ireland and the UK using existing databases such as the Irish Longitudinal Study on Ageing (TILDA), the English Longitudinal Study on Ageing (ELSA) and Whitehall II.
This project involves collaboration between the Royal College of Surgeons in Ireland and the University of Cambridge, and will involve a three-month placement at the University of Cambridge