Rather than viewing health risks from alcohol as being
outweighed by its desirability, older people may reason around
alcohol primarily in social or moral rather than health terms [24].
Heavy drinking in this age group is subject to particular stigma
[18,28–30]. Given the gendered patterns of alcohol consumption
[31], this may be especially so for women’s drinking; women in
mid to later life, for instance, may perceive particular pressure to
present their drinking as appropriate and moderate in a way that
men of the same age do not [32,33]. Although stigma may increase
the isolation older people already suffer disproportionately, and
hamper the identification and prevention of risks to their health
from alcohol, there has been little elaboration of how this is
maintained and exerts influence. Identity theory suggests that over
successive transitions in life, older people will have rehearsed and
accumulated preferred versions of self within which to frame
themselves and their experience [34,35]. These identities will be
multiple, mutable and responsive to personal, temporal, social and
cultural contexts [36]. An older person may for instance move
between representing themselves as a matriarch or patriarch, a
patient, someone winding down their working life, or someone
active or ‘young for their age’. Such identities are likely to ascribe
particular meanings for alcohol use, behaviour which has
considerable and diverse cultural connotations. In public health
terms, heavy drinking and dependence on alcohol represent
differing degrees of problems and health impacts. However, being
a heavy drinker may underpin important community or family identities that are challenged by significant health events or
bereavement in later life. Identity as someone dependent on
alcohol may carry particularly adverse moral associations for older
people. Relinquishing a version of self that is cherished as normal
in favour of new, healthier identities implies a greater challenge in
later life than simply recognising that health is at risk.
These social theories have distinct implications for understanding
why older people may be drinking more. We report a
qualitative study in the UK, where substantial numbers of
individuals over the age of 50 exceed governmental recommendations
that adults (women/men) should not drink more than 3/4
units of 8 g of alcohol per day or 14/21 units per week [11]. This
research aimed to elucidate the views of older individuals aged
over 50 years about alcohol consumption, health and well-being,
to inform future targeted prevention in this group. The findings
provide insight into older people’s constructions of drinking
behaviour in both health and social terms, and highlight that
stigma around problem drinking in this age group may lead to
moral reasoning being prioritised over public health rationales.