Study finds alcohol emergency department presentations increasing among older New Zealanders

Findings from a new University of Otago, Christchurch, study suggest alcohol harm is becoming more prevalent among older New Zealanders but less so among youth, with alcohol-related presentations placing a significant but preventable burden on the motu's over-stretched hospital emergency departments.

The study, The Impact of alcohol in the ED, published in today's New Zealand Medical Journal, provides a detailed 'snapshot' of alcohol-related patient presentations to the Christchurch Hospital emergency department over three separate but similar timeframes in 2013, 2017 and 2022.

Lead researcher Dr. Laura Joyce, a Christchurch Hospital Emergency Physician and Senior Lecturer at the University's Christchurch campus says overall, the study found no "let-up" in the number of alcohol-related presentations ED staff were treating over time.

"Excess of alcohol as a reason for presentation to the Christchurch ED in our study rose, from just over five percent in 2013 to 11 percent in 2022," says Dr. Joyce.

"Alcohol harm is pervasive across Aotearoa New Zealand, leading to significant injury and chronic disease, causing more than five percent of all premature deaths."

People presenting to the Christchurch Hospital ED (one of the busiest in Australasia, with over 130,000 presentations annually) were approached and consented to take part in the study if they had ingested alcohol in the four hours prior to presenting, or if their presentation was thought to be due to alcohol.

The study was conducted during a three-week wave of data collection in November/December 2013, 2017, and 2022. Overall, 412 patients consented to take part.

Dr. Joyce says a key study finding was the change in the age profile of older New Zealanders attending the ED with alcohol-related issues.

Over the three waves, the median age of participants increased to 39 years. Specifically, in the 25-54 age group, alcohol presentations rose from 29.9 percent (in 2013) to 40.1 percent (in 2022), and in the over 54 age group, from 11.6 percent (in 2013) to 23.9 percent (in 2022).

"Although media attention often focuses on "young people drinking in pubs and bars on a Saturday night," this is not the case in terms of ED presentations in this study," Dr. Joyce says.

"Our findings are in line with other research showing that over one-third of older New Zealanders are drinking at levels that may result in harm."

"This is concerning, as people in this age group are more likely to have additional co-morbidities and the potential for medication interactions."

Conversely, the study shows a drop in the number of youth presenting to the ED with alcohol-related issues; in 2013, youth aged 25 and under made up 33.6 percent of presentations, dropping to 19.3 percent in 2022.

"This drop in youth drinking, alongside an increase in alcohol consumption by older adults, has also been observed in other high-income countries around the world."

The study shows binge drinking is still prevalent in New Zealand society, with a significant proportion of patients in each wave (26.5 percent in 2022) admitting to having consumed 20 or more standard drinks in a single occasion.

The findings also detected a shift back to on-license alcohol purchases over time (such as bars and clubs), although off-license alcohol purchases (bottle stores, supermarkets, and online sales) remain the primary source of alcohol purchase.

Two-thirds of patients in the study had consumed alcohol (leading to their ED visit) in a private location, such as their own home.

"We feel this highlights the need for stronger local alcohol policies for off-license venues, particularly seeing they are a key supplier of large quantities of cheap alcohol and contribute to New Zealand's drinking culture as a whole," Dr. Joyce says.

"With the recent passing of the Sale and Supply of Alcohol (Community Participation) Amendment Bill, Councils can now implement strong controls on alcohol availability without the risk of alcohol industry appeals, particularly from alcohol retailers."

The study authors say it's highly important that EDs in New Zealand systematically collect alcohol-related data, to help inform effective population-level alcohol policies to reduce excessive drinking.

"Alcohol-related presentations are preventable, contribute to ED overcrowding, impact other patients requiring care, put considerable stress on hospital staff and resources, and place a high financial burden on the entire health system.

"Implementation of evidence-based alcohol policies is urgently needed to reduce the impact of alcohol in the ED and improve the health of our communities," Dr. Joyce says.