Primary care-based intervention to reduce at-risk drinking in older adults: a randomized controlled trial

Abstract

Aims-To examine whether a multifaceted intervention among older at-risk drinking primary care patients reduced at-risk drinking and alcohol consumption at 3 and 12 months. Design-Randomized controlled trial.Setting-Three primary care sites in southern California.Participants-Six hundred thirty-one adults aged ≥ 55 years who were at-risk drinkers identified by the Comorbidity Alcohol Risk Evaluation Tool (CARET) were randomly assigned between October 2004 and April 2007 during an office visit to receive a booklet on healthy behaviors or an intervention including a personalized report, booklet on alcohol and aging, drinking diary, advice from the primary care provider and telephone counseling from a health educator at 2, 4 and 8 weeks.Measurements-The primary outcome was the proportion of participants meeting at-risk criteria, and secondary outcomes were number of drinks in past 7 days, heavy drinking (4 or more drinks in a day) in the past 7 days and risk score.. Conclusions-A multifaceted intervention among older at-risk drinkers in primary care does not reduce the proportions of at-risk or heavy drinkers, but does reduce amount of drinking at 12 months.

The Effect of an Educational Intervention on Alcohol Consumption, At-Risk Drinking, and Health Care Utilization in Older Adults: The Project SHARE Study

“…The data from this trial compare favorably with those from the three other published trials in primary care aimed at reducing some aspect of alcohol consumption among older adults (Fink et al, 2002a;Fleming et al, 1999;Moore et al, 2011). Project GOAL (Guiding Older Adult Lifestyles) was a randomized trial testing the effi cacy of brief physician advice and follow-up nurse calls in reducing alcohol use in problem drinkers ages 65 and older (Fleming et al, 1999).…”

“…However, more than half of the participants in the Fink et al (2005) study were nonhazardous drinkers at baseline, and unmeasured site heterogeneity may have confounded the associations between the treatment arm and patient outcomes. Participants in the Healthy Living as You Age (HLAYA) study were those identifi ed as at-risk drinkers at baseline using the CARET (Moore et al, 2011). All participants in the intervention arm received baseline personalized reports and physician feedback as well as health educator telephone calls at 2, 4, and 8 weeks.…”

“…However, just three studies have focused on older adults (Fink et al, 2005;Fleming et al, 1999;Moore et al, 2011). All three of the studies among older adults were modestly successful in reducing alcohol use and/or at-risk drinking, although each used an approach that differed from Project SHARE (see the Discussion for details).…”

The Prevalence of Harmful and Hazardous Alcohol Consumption in Older U.S. Adults: Data from the 2005–2008 National Health and Nutrition Examination Survey (NHANES)

“…Evidence, based on the use of a modified ARPS system, suggests that providing information on recommended drinking limits to older adults may be enough to cause large reductions in both at-risk drinking and amount of alcohol use, 32 and similar results were found in the Santa Monica trial of the ARPS system. 10 There are many reasons why physicians do not screen their older patients for alcohol misuse or, if they do, why they rely primarily on self-reported alcohol consumption.…”

Treatment of alcohol use disorders in the elderly: an overview of RCTs

“…Interdisciplinary, broad, or multifaceted mental healthcare management programs, either with primary care patients or male veterans, were studied in more RCTs (Bartels et al, 2004;Oslin et al, 2004;Moore et al, 2010;Ettner et al, 2014;Vrdoljak et al, 2014). Disappointingly, only two RCTs (Moore et al, 2010;Ettner et al, 2014) found a statistically significant advantage of intervention over CAU.…”