Interventions to prevent and reduce excessive alcohol consumption in older people: a systematic review and meta-analysis

Abstract

Backgroundharmful alcohol consumption is reported to be increasing in older people. To intervene and reduce associated risks, evidence currently available needs to be identified.Methodstwo systematic reviews in older populations (55+ years): (1) Interventions to prevent or reduce excessive alcohol consumption; (2) Interventions as (1) also reporting cognitive and dementia outcomes. Comprehensive database searches from 2000 to November 2016 for studies in English, from OECD countries. Alcohol dependence treatment excluded. Data were synthesised narratively and using meta-analysis. Risk of bias was assessed using NICE methodology. Reviews are reported according to PRISMA.Resultsthirteen studies were identified, but none with cognition or dementia outcomes. Three related to primary prevention; 10 targeted harmful or hazardous older drinkers. A complex range of interventions, intensity and delivery was found. There was an overall intervention effect for 3- and 6-month outcomes combined (8 studies; 3,591 participants; pooled standard mean difference (SMD) −0.18 (95% CI −0.28, −0.07) and 12 months (6 studies; 2,788 participants SMD −0.16 (95% CI −0.32, −0.01) but risk of bias for most studies was unclear with significant heterogeneity. Limited evidence (three studies) suggested more intensive interventions with personalised feedback, physician advice, educational materials, follow-up could be most effective. However, simple interventions including brief interventions, leaflets, alcohol assessments with advice to reduce drinking could also have a positive effect.Conclusionsalcohol interventions in older people may be effective but studies were at unclear or high risk of bias. Evidence gaps include primary prevention, cost-effectiveness, impact on cognitive and dementia outcomes.

Alcohol and older people: A systematic review of barriers, facilitators and context of drinking in older people and implications for intervention design

“…A recent systematic review of interventions to prevent or reduce excessive alcohol consumption in older people identified 13 studies, most relating to reduction of drinking in ‘at risk’ drinkers, with few primary prevention studies in older people [ 28 ]. That review found some evidence that more intensive interventions involving personalised feedback, physician advice and educational materials with follow-up may be most effective in older people.…”

Alcohol complicates multimorbidity in older adults

“…12 Support for effective interventions for unhealthy drinking in older adults is more meagre still, with mixed results from a small number of trials of low-to-moderate quality. 13 Worldwide, there are no trials evaluating interventions that tackle drinking in older people with multimorbidity.…”

A Pilot Follow‐Up Study of Older Alcohol‐Dependent COGA Adults

“…It is worth noting that only a relatively small proportion (19%) of the oldest participants received any treatment for their alcohol problems within the past 5 years, whether formal or self‐help in nature. This suggests a public health need that is not being sufficiently addressed (Kelly et al., ), particularly in light of the high risk for medical problems and early death associated with heavy drinking among older adults (Breslow et al., ; Vestal et al., ).…”