Evaluation of Australia’s first older adult-specific early intervention for reducing alcohol-related harmStephen J. Bright A B E and Cylie M. Williams C D
A Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia.
B Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
C Peninsula Health, PO Box 52, Frankston, Vic. 3199, Australia. Email: firstname.lastname@example.org
D Monash University, School of Primary Health Care, Mcmahons Road, Frankston, Vic. 3199, Australia.
E Corresponding author. Email: email@example.com
Australian Health Review - https://doi.org/10.1071/AH17013
Submitted: 5 February 2017 Accepted: 8 May 2017 Published online: 6 July 2017
The aim of the present case study was to evaluate the service-wide implementation of Australia’s first older adult-specific early intervention called Older Wiser Lifestyles (OWL). OWL was designed to reduce alcohol consumption and alcohol-related harm among people identified as being at risk. OWL used the Australian Alcohol-Related Problems Survey (A-ARPS) to classify people’s drinking patterns as non-hazardous, hazardous or harmful. Participants of the present study were aged ≥60 years and consumed alcohol in the past month, although they did not require treatment for dependence. The Alcohol Use Disorders Identification Test – Consumption (AUDIT-C) was used as a composite measure of alcohol consumption. Data were collected before intervention and 3 and 6 months after intervention. In all, 140 clients were screened and attended at least one appointment (54% male; mean (± s.d.) age 72.8 ± 7.6 years). Generalised estimating equation (GEE) examined the correlations between the intervention groups, time point and outcomes of interest. At 6 months, significant reductions were observed in A-ARPS classification (P = 0.001) and AUDIT-C scores (P = 0.001) among all clients, regardless of the number of sessions or intervention group. These preliminary findings warrant a randomised clinical trial of the intervention. Until this is completed, Australian health care providers should still consider the early intervention to reduce the risk of alcohol consumption among older adults.
What is known about this topic? Older Australians are increasingly drinking alcohol at levels that place them at risk of experiencing harm. Although early interventions have been developed overseas that have been shown to reduce risky drinking among older adults, no such program has been implemented in Australia.
What does this paper add? We developed an early intervention program (OWL) that drew from and extended intervention protocols developed overseas. In particular, we added harm reduction as a component of the intervention. Harm reduction interventions do not appear to have been evaluated among older adults. The OWL program was evaluated and found to be associated with decreased levels of alcohol-related harm.
What are the implications for practitioners? Older adults have different needs when it comes to considering risk of alcohol-related harm. Many are taking medications that interact with alcohol or have comorbid conditions that can be exacerbated by alcohol or more difficult to treat. Yet, many such individuals are not considered to be at risk due to poor screening among this population. The program we developed takes into account these age-specific factors and has been manualised. As such, it could be implemented by a variety of healthcare workers in numerous settings. We hope that practitioners are interested in trialling the program and that a randomised controlled trial is conducted to establish the efficacy of the program.
References Anderson P, Laurant M, Kaner E, Wensing M, Grol R. Engaging general practitioners in the management of hazardous and harmful alcohol consumption: results of a meta-analysis. J Stud Alcohol 2004; 65 191–9.
| Engaging general practitioners in the management of hazardous and harmful alcohol consumption: results of a meta-analysis.CrossRef |
 Bright SJ, Williams CM. Development of Australia’s first older adult-specific early intervention for alcohol-related harm: feasibility and proof of concept. Australas J Ageing 2017; 36 52–5.
| Development of Australia’s first older adult-specific early intervention for alcohol-related harm: feasibility and proof of concept.CrossRef |
 Schonfeld L, King-Kallimanis BL, Duchene DM, Etheridge RL, Herrera JR, Barry KL, Lynn N. Screening and brief intervention for substance misuse among older adults: the Florida BRITE project. Am J Public Health 2010; 100 108–14.
| Screening and brief intervention for substance misuse among older adults: the Florida BRITE project.CrossRef |
 Fink A, Elliott MN, Tsai M, Beck JC. An evaluation of an intervention to assist primary care physicians in screening and educating older patients who use alcohol. J Am Geriatr Soc 2005; 53 1937–43.
| An evaluation of an intervention to assist primary care physicians in screening and educating older patients who use alcohol.CrossRef |
 Moore AA, Blow FC, Hoffing M, Welgreen S, Davis JW, Lin JC, Ramirez KD, Liao DH, Tang L, Gould R, Gill M, Chen O, Barry KL. Primary care-based intervention to reduce at-risk drinking in older adults: a randomized controlled trial. Addiction 2011; 106 111–20.
| Primary care-based intervention to reduce at-risk drinking in older adults: a randomized controlled trial.CrossRef |
 Center for Substance Abuse Treatment. Substance abuse among older adults. Treatment improvement protocol (TIP) series 26. Rockville, MD: Substance Abuse and Mental Health Services Administration; 1998.
 Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahmed K, Bray J. Screening, brief intervention, and referral to treatment (SBIRT) toward a public health approach to the management of substance abuse. Subst Abus 2007; 28 7–30.
| Screening, brief intervention, and referral to treatment (SBIRT) toward a public health approach to the management of substance abuse.CrossRef |
 Miller WR. Increasing motivation for change. In: R. K. Hesters & W. R. Miller, editors. Handbook of alcoholism treatment approaches: Effective alternatives, 3rd edn. Needham Heights, MA: Allyn & Bacon; 2003. pp. 89–104.
 Bright SJ, Fink A, Beck JC, Gabriel J, Singh D. Development of an Australian version of the alcohol-related problems survey (A-ARPS): a comprehensive computerised screening tool for older adults. Australas J Ageing 2015; 34 33–7.
| Development of an Australian version of the alcohol-related problems survey (A-ARPS): a comprehensive computerised screening tool for older adults.CrossRef |
 Crome I, Wu L-T, Rao RT, Crome P. Substance use and older people. Oxford John Wiley & Sons; 2014.
 Moore AA, Beck JC, Babor TH, Hays RD, Rueben DB. Beyond alcoholism: identifying older, at-risk drinkers in primary care. J Stud Alcohol 2002; 63 316–24.
| Beyond alcoholism: identifying older, at-risk drinkers in primary care.CrossRef |
 Babor T, Higgins-Biddle J, Saunders J, Monteiro M. The alcohol use disorders identification test guidelines for use in primary care. 2nd edn. Geneva: World Health Organization; 2001.
 Twisk JW. Commentary: the problem of evaluating the magnitude of tracking coefficients. Eur J Epidemiol 2003; 18 1025–6.
| Commentary: the problem of evaluating the magnitude of tracking coefficients.CrossRef |
 Lippke S, Schwarzer R, Ziegelmann JP, Scholz U, Schüz B. Testing stage-specific effects of a stage-matched intervention: a randomized controlled trial targeting physical exercise and its predictors. Health Educ Behav 2010; 37 533–46.
| Testing stage-specific effects of a stage-matched intervention: a randomized controlled trial targeting physical exercise and its predictors.CrossRef |