Drink wise, age well; reducing alcohol related harm among people over 50: a study protocol

[The influence of an age-specific treatment setting on the success of inpatient detoxification treatment in older patients with substance-related disorders]

In this study, the success of inpatient qualified withdrawal treatment in an age-specific setting was compared with that in a mixed-age setting.175 patients (137 male, average age 59.4 years) with different substance-related disorders were examined. Treatment success was defined as the regular termination of treatment.During the observation period significantly more elderly patients were admitted to the age-specific setting than to the mixed-age setting. Regardless of the treatment setting, more than 80% of patients completed withdrawal treatment regularly. For the overall group as well as for the subgroup of opioid dependent persons in maintenance treatment, withdrawal treatment was significantly more successful in an age-specific setting.The demographic development and these results speak in favor of the implementation of age-specific services for older patients with substance-related disorders.

The acceptability of alcohol screening and brief intervention for older adults in community venues

BACKGROUND

Evidence supports the effectiveness of alcohol brief interventions (ABI) in health-care settings but the acceptability of conducting ABIs in wider community venues such as supermarkets, hospital atriums and train stations remains unclear. This study examines the acceptability of conducting ABIs for older adults in community settings.

METHOD

ABIs were conducted in community venues in five sites across the United Kingdom as part of the Drink Wise, Age Well program. ABIs used the Alcohol Use Disorders Identification Test-Consumption to measure alcohol use, with personalised feedback delivered in relation to alcohol intake. Data on age, gender, ethnicity, alcohol use and intention to change drinking was collected. Qualitative interviews to explore the acceptability of delivering ABIs within community venues were conducted with a sub-set of ABI recipients (n = 16) and practitioners (n = 12). Data were analysed using Framework Analysis.

RESULTS

A total of 3999 people received an ABI. Fifty-eight percent of ABI recipients were female. The largest age group was 50-54 years (28%). Almost 80% (n = 3180) of ABI recipients were drinking at hazardous levels. Of hazardous drinkers that were asked (n = 2726), 40% reported intentions to change their drinking. Qualitative analysis indicted that ABIs conducted in community venues were acceptable and considered to be valuable in raising awareness of alcohol-related risks.

DISCUSSION AND CONCLUSIONS

Community venues represent a promising context to engage older people in alcohol intervention, with the potential to lead to reductions in alcohol consumption.

Professionals' perspectives on interventions to reduce problematic alcohol use in older adults: a realist evaluation of working elements

OBJECTIVES

This study set out to understand how (which elements), in what context and why (which mechanisms) interventions are successful in reducing (problematic) alcohol use among older adults, from the perspective of professionals providing these interventions.

DESIGN

Guided by a realist evaluation approach, an existing initial programme theory (IPT) on working elements in alcohol interventions was evaluated by conducting semistructured interviews with professionals.

SETTING AND PARTICIPANTS

These professionals (N=20) provide interventions across several contexts: with or without practitioner involvement; in-person or not and in an individual or group setting. Data were coded and links between contexts, elements, mechanisms and outcomes were sought for to confirm, refute or refine the IPT.

RESULTS

From the perspective of professionals, there are several general working elements in interventions for older adults: (1) pointing out risks and consequences of drinking behaviour; (2) paying attention to abstinence; (3) promoting contact with peers; (4) providing personalised content and (5) providing support. We also found context-specific working elements: (1) providing personalised conversations and motivational interviewing with practitioners; (2) ensuring safety, trust and a sense of connection and a location nearby home or a location that people are familiar with in person and (3) sharing experiences and tips in group interventions. Furthermore, the mechanisms awareness and accessible and low threshold participation were important contributors to positive intervention outcomes.

CONCLUSION

In addition to the IPT, our findings emphasise the need for social contact and support, personalised content, and strong relationships (both between client and practitioner, and client and peers) in interventions for older adults.

The characteristics and treatment outcomes of people with very late onset of problem drinking

BACKGROUND

The characteristics and outcomes of people who begin to experience problems with alcohol later in life are not well understood. This study examines whether people with a very late-onset of problem drinking, defined as occurring after the age of 60, differ in their use of alcohol, mental health functioning, and alcohol treatment outcomes from people with an earlier onset of problem drinking.

METHOD

Seven hundred eighty participants aged 50+ were categorized as either early onset (<25 years, n = 119, 15%), mid-onset (25-39 years, n = 200, 26%), late-onset (40-59 years, n = 376, 48%) or very late-onset problem drinkers (≥60 years, n = 85, 11%). Participants completed measures on alcohol use, mental health, and cognitive functioning.

RESULTS

Eleven percent of participants had very late onset of problem drinking. After controlling for age as a covariate, age of onset of problem drinking was not associated with level of alcohol intake or cognitive functioning, but individuals with very late onset of problem drinking had significantly lower levels of depression and significantly better mental health well-being. Age of onset was not associated with treatment outcomes (i.e., change in alcohol use following treatment or treatment completion).

CONCLUSION

People who first experience problems with alcohol after the age of 60 may have better mental health functioning than people with an earlier age of problem drinking. The results suggest that the age of onset of problem drinking may be a poor predictor of alcohol use severity and treatment outcomes and older adults can benefit from alcohol treatment irrespective of the age problem drinking began.

Social capital and alcohol risks among older adults (50 years and over): analysis from the Drink Wise Age Well Survey

Although there has been significant research on the relationship between alcohol consumption and demographic and psychological influences, this does not consider the effect of social influence among older drinkers and if these effects differ between men and women. One aspect of social influence is social capital. The aim of this paper is to examine whether relational and cognitive social capital are associated with higher or lower risk of alcohol use among adults aged 50 years or older and to assess the extent to which this relationship differs between men and women. To investigate this, data were collected from a cross-sectional questionnaire survey of adults over the age of 50 in the United Kingdom who were recruited from general practitioners. The sample consisted of 9,984 individuals whose mean age was 63.87 years. From these data, we developed proxy measures of social capital and associate these with the respondent's level of alcohol consumption as measured on the Alcohol Use Disorders Identification Test (AUDIT-10) scale. In the sample, just over 20 per cent reported an increasing risk or dependency on alcohol. Using two expressions of social capital – relational (social relationships) and cognitive (knowledge acquisition and understanding) – we found that greater levels of both are associated with a reduced risk of higher drinking risk. Being female had no significant effect when combined with relational capital but did have a significant effect when combined with cognitive capital. It is argued that interventions to enhance social relations among older people and education to help understand alcohol risks would be helpful to protect older people from the damaging effects of excessive alcohol consumption.

Cognitive impairment and treatment outcomes amongst people attending an alcohol intervention service for those aged 50+

Purpose

No studies have evaluated the relationship between cognitive impairment and alcohol treatment outcomes amongst older drinkers. This study aims to explore the extent of cognitive impairment amongst older adults seeking alcohol treatment and examine the relationship between cognitive impairment, treatment retention and alcohol use following treatment.

Design/methodology/approach

The study used data from the Drink Wise Age Well programme; an alcohol intervention service for older adults (aged 50+). The Montreal Cognitive Assessment was used to screen for cognitive impairment; alcohol use was assessed using the alcohol use disorders identification test.

Findings

In total, 531 participants completed the assessment at treatment entry. Over half the sample were male (57%), with a mean age of 60 years (Standard deviation: 7.09). Almost half (48.4%) had cognitive impairment at the entry to treatment: 51.6% had a normal cognitive function, 41.4% had mild cognitive impairment, 5.8% had moderate cognitive impairment and 1.1% had severe cognitive impairment. Cognitive impairment was not associated with increased treatment drop-out and was not predictive of alcohol use following treatment. Alcohol treatment was associated with a significant improvement in cognitive functioning.

Originality/value

This study suggests there may be a significant amount of unidentified cognitive impairment amongst older adults attending alcohol treatment. Assessment and routine screening for cognitive impairment in drug and alcohol services may help in care planning and setting treatment goals; in the absence of routine screening opportunities for treatment planning and intervention may be missed.

Factors influencing routine cognitive impairment screening in older at-risk drinkers: Findings from a qualitative study in the United Kingdom

Cognitive Impairment (CI) screening is recommended for those engaged in harmful levels of alcohol use. However, there is a lack of evidence on implementation. This paper explores the barriers and facilitators to CI screening experienced across a service specifically for older drinkers. The findings draw on data gathered as part of an evaluation of a multilevel programme to reduce alcohol-related harm in adults aged 50 and over in five demonstration areas across the United Kingdom. It is based on qualitative interviews and focus groups with 14 service providers and 22 service users. Findings are presented thematically under the section headings: acceptability of screening, interpretation and making sense of screening and treatment options. It is suggested that engagement with CI screening is most likely when its fit with agency culture and its purpose is clear; where service providers have the technical skills to administer and discuss the results of screening with service users; and where those undertaking screening have had the opportunity to reflect on their own experience of being screened. Engagement with CI screening is also most likely where specific intervention pathways and engagement practices can be accessed to respond to assessed need.

Alcohol use and dementia: new research directions

PURPOSE OF REVIEW

Alcohol is gaining increased recognition as an important risk factor for dementia. This review summarises recent evidence on the relationship between alcohol use and dementia, focusing on studies published from January 2019 to August 2020.

RECENT FINDINGS

Epidemiological data continues to yield results consistent with protective effects of low-to-moderate alcohol consumption for dementia and cognitive function. However, recent literature highlights the methodological limitations of existing observational studies. The effects of chronic, heavy alcohol use are clearer, with excessive consumption causing alcohol-related brain damage. Several pathways to this damage have been suggested, including the neurotoxic effects of thiamine deficiency, ethanol and acetaldehyde.

SUMMARY

Future research would benefit from greater implementation of analytical and design-based approaches to robustly model the alcohol use-dementia relationship in the general population, and should make use of large, consortia-level data. Early intervention to prevent dementia is critical: thiamine substitution has shown potential but requires more research, and psychosocial interventions to treat harmful alcohol use have proven effective. Finally, diagnostic criteria for alcohol-related dementia require formal validation to ensure usefulness in clinical practice.

Community Based Interventions for Problematic Substance Use in Later Life: A Systematic Review of Evaluated Studies and Their Outcomes

Problematic substance use (PSU) in later life is a growing global problem of significant concern in tandem with a rapidly ageing global population. Prevention and interventions specifically designed for older people are not common, and those designed for mixed-age groups may fail to address the unique and sometimes complex needs of ageing communities. We report findings from a systematic review of the empirical evidence from studies which formally evaluated interventions used with older people and reported their outcomes. Nineteen studies were included, of which thirteen focused solely on alcohol-related problems. Eight interventions utilised different types of screening, brief advice and education. The remaining drew on behavioural, narrative and integrated or multi-disciplinary approaches, which aimed to meet older people's needs holistically. Quality assessment of study design helped to review evaluation practice. Findings point to recommendations for sustainable and well-designed intervention strategies for PSU in later life, which purposefully align with other areas of health and well-being and are delivered in locations where older people normally seek, or receive, help. There is further scope for engagement with older people's own perspectives on their needs and help-seeking behaviours. Economic evaluation of the outcome of interventions would also be useful to establish the value of investing in targeted services to this underserved population.

Alcohol and public mental health for older people: 20 years of UK policy change

Purpose

The purpose of this paper is to detail developments in UK alcohol policy for older people over the past 20 years, based on evidence for a growing public health problem with alcohol misuse in older people.

Design/methodology/approach

A literature search was carried out using health and social care databases, including grey literature.

Findings

There has been considerable progress in areas such as screening and brief intervention, low-risk drinking and service provision for integrated care in older people with dual diagnosis.

Research limitations/implications

There remains a dearth of research and policy for older people with alcohol misuse and dual diagnosis prior to 2011. Although there remains limited empirical evidence for public health interventions to improve health outcomes from alcohol-related harm, improvements in population health from implementation of recent policy changes and intervention programmes remains to be seen.

Practical implications

This review has implications for best practice in the provision of integrated care to reduce harm and improve health and social outcomes in older people with alcohol misuse and dual diagnosis.

Originality/value

This review draws together a large area of research and policy on alcohol misuse in older people that has the potential to improve public mental health for older people who are at risk of alcohol-related harm.

Prevalence and sociodemographic factors of risky drinking in Australian older adults

INTRODUCTION AND AIMS

This study describes the prevalence of risky drinking in older adults (aged 60+ years) in Australia and explores the socioeconomic and lifestyle factors associated with this. The negative consequences of drinking behaviours in older adults were also explored.

DESIGN AND METHODS

Cross-sectional design, with data obtained from the Australian 2016 National Drug Strategy Household Survey, yielding a sample size of 7976 participants. Multivariable logistic regression was used to assess the correlates of risky drinking.

RESULTS

Approximately 17% of older Australians reported risky drinking and their most popular drinking location was in the home (93%). Respondents who were male [odds ratio 3.78, 95% confidence interval (3.22, 4.43)], of younger age group (60-69 years) [2.96, (2.25, 3.89)], in a higher socioeconomic status [1.76, (1.41, 2.21)], had no dependents [1.51, (1.10, 2.07)], were unemployed [1.64, (1.10, 2.44)] and were either current or ex-smokers [2.32, (1.90, 2.83) or 3.55, (2.95, 4.29)], were more likely to report risky drinking. Approximately 54% of risky drinkers experienced a negative outcome as a result of their drinking in the last year.

DISCUSSION AND CONCLUSIONS

Risky drinking in older adults is a key public health issue, with a concerning rate of risky drinking and associated negative outcomes seen in the current study. Interventions aimed at older drinkers thus need to focus beyond socio-economically disadvantaged groups, while self-moderation on risky drinking, controlling accessibility to take-away alcohol and increasing the awareness of harms of risky drinking may help to reduce risky drinking among older people.