By Julie Breslin, Head of Programme Drink Wise, Age Well, with additional content by Beth Bareham, Post-doctoral researcher, Newcastle University Institute of Health and Society/Institute for Ageing.
In England and Scotland, drinkers aged 55-64 are more likely to exceed the recommended weekly guidelines
than any other age group. In a survey of nearly 17,000 adults aged over 50, three quarters did not know what the then recommended alcohol guidelines were. In the general over 50s population there is both low awareness of what we should be drinking, and an overall increase in consumption levels. This raises a significant public health concern which we’ll be considering at the Alcohol Change UK conference in a session on public health and alcohol, which I’m co-hosting with Will Haydock.
Delivering Alcohol Brief Interventions (ABIs) in public spaces is a significant component of the Drink Wise, Age Well
programme’s prevention approach. Locations include train stations, supermarkets and hospital lobby areas.
We know that ABIs can reach people who need to reduce their consumption: when we analysed the scores of nearly 3,000 screenings delivered by us (using the AUDIT-C screening tool, with an age-adjusted
hazardous score of 3+ for women and 4+ for men) we found that 84.7% of women and 79% of men obtained a score that indicated hazardous alcohol use. For almost 40% of those screened, this was reportedly the first time they had been asked these questions about their drinking.
But until now there has been little evaluation of how ABIs are received by an older population, in a public setting. Academics and practitioners often express concerns that alcohol is a sensitive topic for discussion with older adults. It’s important to understand whether older adults see Drink Wise, Age Well’s approach of talking about alcohol in public as acceptable.
In addition, although there is some evidence suggesting that ABIs are effective with older people, approaches are not always tailored to the older age group, and vary greatly. The team at Drink Wise, Age Well are experienced in engaging older adults, knowledgeable about specific risks of drinking with age, and have opportunity to signpost individuals to wider elements of the programme
for further support. However, as ABIs rarely involve follow-up, they get little indication as to whether these conversations are effective in leading older members of the public to change how they think about, or use, alcohol.
So there was a real need for proper research into the effectiveness of ABIs delivered in public places for older people.
We had the fortuitous opportunity of a post-doctoral student from Newcastle University joining our Glasgow team who has spent the last three and a half years working to understand health-related, psychological and social factors that shape the way older people use alcohol, and was eager to apply this learning to understand how older people’s drinking might be addressed.
With funding from the Faculty of Medical Sciences, Beth brought her qualitative research skills and understanding of older adults’ drinking to evaluate approaches within Drink Wise, Age Well, in particular how the prevention team support older people to understand their drinking in terms of units and calories. Earlier findings suggested that older adults can struggle with this language, relying instead on their view of ‘appropriate’ alcohol use learned from the behaviour of people around them throughout their lives. This can promote drinking in excess of drinking guidelines.
Findings indicate that guiding older people to break down and translate their routine drinking into units, and exploring potential effects of their intake on their health, gives older adults the motivation and agency to make calculated changes in their drinking to reduce health risks. As a result, a substantial proportion of individuals involved in the study to date have made changes to reduce their overall alcohol intake. The approach appears to engage those who are comfortable with their alcohol intake (many of whom are drinking at potentially harmful levels), and who are happy to learn about their drinking and how they might make healthier choices.
This is a really promising finding as cultural norms can be difficult to address, but doing so is vital as they appear to shape decisions for drinking, and lead to people viewing potentially harmful drinking as ‘safe’. From a research and practice approach, this gives will help shape future work to develop tailored interventions within primary care for the older age group.
We will soon publish a collaborative Insight Report, which will detail how this approach works to change older people’s understanding of their drinking, and ‘top tips’ for how to provide the service effectively and address any challenges.
