1. Addressing older care recipients’
alcohol misuse
An exploration of primary care providers’ views of facilitating and hindering factors
Jemma Stewart1(SPCR student intern), Bethany Bareham1, Eileen Kaner1 & Barbara Hanratty1
1 Newcastle University, United Kingdom
Aim
Findings
This qualitative study aimed to examine primary care providers’ perceptions of factors that facilitate and hinder their work to address older adults’ alcohol misuse.
Discordance between drinking guidelines and cultural norms represented a challenge for practice. Cultural acceptability of alcohol from an early age creates habits that are entrenched by later life.
"I find that recently for most people that I see that drink, that we talk about they're over the guidance, that actually it almost seems like the guidance is too low. Then it's a difficult conversation to have because there's visibly quite a gap” – GP
Background
Negative effects of alcohol upon common late-life conditions and medications mean older people may experience harm from drinking.
Motivation to discuss alcohol misuse with older care recipients was impacted by care providers’ perceptions of the roles of alcohol in older people’s lives and the perceived sensitivity of the topic for discussion.
Alcohol can play positive roles in older people’s social lives.
“If you’re over-drinking, obviously, the effects are bad, but, going out socially, it’s not depriving you of being stuck in the house and depressed.” - Carer
Older people’s drinking represents a complex issue to negotiate within primary care.
“I think we know that the more people mention things like smoking and alcohol, the more people do take notice and it becomes less of a big issue, the fact that you're talking about it.” – GP
An understanding of primary care providers’ perceptions of facilitating and hindering factors for addressing older adults’ alcohol misuse is helpful to reflect on making these conversations more beneficial in the future.
Care providers’ perceptions of their remit and demarcations of interprofessional responsibility hindered consultations when unclear, and enhanced discussions when clear.
Methods
“It should be a combined approach… They should have support from multiple places.” - Dentist
Thirty-five primary care providers (GPs, practice and district nurses, health care assistants, pharmacists, dentists, social workers, home care providers) participated in 13 semi-structured interviews and focus groups exploring their views and experiences of older people’s drinking.
A clear cut referral pathway was an important facilitator for meaningful intervention when alcohol misuse was identified.
“If you can intervene and say, “This is really important and I want you to go and see these people, make that appointment, and phone that number. Do you promise to do that?” that will increase the value of what you’re doing, hugely.” GP
Data were analysed thematically.
“Usually what you find is the GPs have a better set-up and they’re more capable of doing it. We don’t have a referral, do we? We just say, “Go to your GP.”” – Dentist
Conclusions
Self-disclosure of drinking practices was perceived to be a barrier; patients’ descriptions of their alcohol use required time (a limited resource) to understand.
Alcohol-related guidelines and referral pathways must be developed to reflect older adults’ specific risks and needs. In equipping care providers with appropriate knowledge, support, pathways and skills, alcohol misuse within the older population may be addressed in primary care settings in the face of entrenched structural and cultural barriers.
“it does amaze me and amuse me, how many people over 65 give the impression that they just don’t drink alcohol anymore. But then when you actually question them further, they do drink quite a bit.” Pharmacist
“Nailing down exactly how much people drink can be a bit of drawn-out process.” GP
Many older people can be open to discussions if relevant to their condition, but they want to feel respected regarding their acquired experience in managing alcohol use. Some issues of disclosure and risk seem relevant to all age groups – the key difference here is greater age and health conditions that may accumulate with age.
References available on request