Factors affecting primary care practitioners’ alcohol-related discussions with older adults: a qualitative study

Abstract

Background: Risk of harm from drinking is heightened in later life, due to age-related sensitivities to alcohol. Primary care services have a key role in supporting older people to make healthier decisions about alcohol. Aim: To examine primary care practitioners’ perceptions of factors that promote and challenge their work to support older people in alcohol risk-reduction. Design and Setting: Qualitative study consisting of semi-structured interviews and focus groups with primary care practitioners in Northern England. Method: Thirty-five practitioners (general practitioners, practice/district nurses, pharmacists, dentists, social care practitioners, domiciliary carers) participated in eight interviews and five focus groups. Data were analysed thematically, applying principles of constant comparison. Results: Practitioners highlighted particular sensitivities amongst older people to discussing alcohol, and reservations about older people’s resistance to making changes in old age; given drinking practices could be established, and promote socialisation and emotional wellbeing in later life. Age-related health issues increased older people’s contact with practitioners; but management of older people’s long-term conditions was prioritised over discussion of alcohol. Dedicated time to address alcohol in routine consultations with older people, and training in alcohol intervention facilitated practitioners; particularly pharmacists and practice nurses. Conclusion: There are clear opportunities to support older people in primary care to make healthier decisions about alcohol. Dedicated time to address alcohol, training in identification of alcohol-related risks, particularly those associated with old age; and tailored interventions for older people, feasible to implement in practice settings, would support primary care practitioners to address older people’s alcohol use.

Alcohol and physical activity screening in the National Health Service Health Check programme: Comparison of medical records and actual practice

“…Other studies have shown that poor adherence to screening for alcohol and physical activity are thought to be a result of limited training, lack of confidence or time, concerns about the impact on the practitioner-patient relationship, and patient compliance [ 5 , 7 , 8 ]. Practitioners perceive alcohol screening to be a sensitive topic for older individuals, adding concerns about stigma, particularly for individuals who consume more than the recommend guidelines [ 9 ]. Those engaged in heavy drinking are also perceived to be more likely to lie about their alcohol consumption, and are less supportive of routine screening for alcohol intake than those who drink less [ 10 ].…”

Prevalence and Predictors of Increased and Hazardous Alcohol Consumption in a Cohort of Older South Australian Men during COVID-19 Restrictions

“…Given these barriers, practice nurses -who are often experienced in assessment, preventive care, and brief interventions -may be well-positioned to support or carry out these activities concerning older men's alcohol use. 84 In Australia, almost two-thirds (64%) of alcohol and other drug services clients receiving alcohol treatments are male, 85 suggesting these services may be particularly accessible for men. Practitioners and services such as these specialised alcohol services, mental health practitioners, community-based programs, and support groups may play important roles in caring for older men engaging in problematic alcohol use; however, little is known about the appeal and efficacy of these avenues for older men.…”

Efetividade da intervenção breve para redução do consumo de risco de álcool em idosos na atenção primária à saúde

“…Outras barreiras incluíam identificar o consumo de risco e não saber intervir, responsabilizar exclusivamente os idosos pela prevenção à saúde e atribuir o uso "moderado" de álcool como aceitável (CHAN et al, 2021). A presença de obstáculos ao se movimentar na comunidade, a incapacidade de lidar com recursos financeiros , a falta de tempo devido as exigências de outras demandas de cuidado na APS e os desafios de integrar uso de instrumentos específicos para idade na rotina de trabalho também podem contribuir para efeitos negativos no cuidado em relação ao álcool (BAREHAM et al, 2021;DIBARTOLO;JAROSINSKI, 2017;MOORE, 2018;LAL;PATTANAYAK, 2017).…”

“…A compreensão dos principais riscos associados ao consumo de álcool e das barreiras à mudança podem tornar mais eficazes a triagem e a intervenção breve para o idoso (HAN; MOORE, 2018). Dado o envelhecimento da população que faz consumo de risco de álcool, são urgentemente necessárias intervenções personalizadas, proativas e multidimensionais (BAREHAM et al, 2021). Essas ferramentas contribuirão para reduzir os comportamentos de risco, minimizar o início e as consequências graves do consumo de álcool, prevenir recaídas e sensibilizar os idosos que apresentam dificuldades em procurar ajuda (DIBARTOLO; JAROSINSKI, 2017) ou que não tem acesso regular aos serviços na APS .…”

“…Os profissionais de saúde carecem de formações sobre os instrumentos de rastreamento e conhecimento das estratégias de intervenções apropriados aos idosos na modalidade presencial ou on-line (BARNES et al, 2016;MOORE, 2018;MAURO;ASKARI;HAN, 2021), bem como necessitam de disponibilidade de tempo para acolher as necessidades dos idosos em relação ao consumo de álcool (BAREHAM et al, 2021;MOORE, 2018;WOOTEN et al, 2017).…”