Abstract
BackgroundThere is a wealth of evidence regarding the detrimental impact of excessive alcohol consumption. In older populations excessive alcohol consumption is associated with increased risk of coronary heart disease, hypertension, stroke and a range of cancers. Alcohol consumption is also associated with an increased risk of falls, early onset of dementia and other cognitive deficits. Physiological changes that occur as part of the ageing process mean that older people experience alcohol related problems at lower consumption levels. There is a strong evidence base for the effectiveness of brief psychosocial interventions in reducing alcohol consumption in populations identified opportunistically in primary care settings. Stepped care interventions involve the delivery of more intensive interventions only to those in the population who fail to respond to less intensive interventions and provide a potentially resource efficient means of meeting the needs of this population.Methods/designThe study design is a pragmatic prospective multi-centre two arm randomised controlled trial. The primary hypothesis is that stepped care interventions for older hazardous alcohol users reduce alcohol consumption compared with a minimal intervention at 12 months post randomisation. Potential participants are identified using the AUDIT questionnaire. Eligible and consenting participants are randomised with equal probability to either a minimal intervention or a three step treatment approach. The step treatment approach incorporates as step 1 behavioural change counselling, step 2 three sessions of motivational enhancement therapy and step 3 referral to specialist services. The primary outcome is measured using average standard drinks per day and secondary outcome measures include the Drinking Problems Index, health related quality of life and health utility. The study incorporates a comprehensive economic analysis to assess the relative cost-effectiveness of the interventions.DiscussionThe paper presents a protocol for the first pragmatic randomised controlled trial evaluating the effectiveness and cost-effectiveness of stepped care interventions for older hazardous alcohol users in primary care.Trial registrationISRCTN52557360
Highlights
There is a wealth of evidence regarding the detrimental impact of excessive alcohol consumption
There exists a wealth of evidence regarding the detrimental impact of hazardous alcohol consumption, consuming more than the weekly recommended number of standard alcohol units in any week (21 for males, 14 for females) or half of the recommended number of standard alcohol units in any one day (10 for males, 7 for females), on the physical and mental health of the population
It is estimated that hazardous alcohol consumption accounts for 150000 hospital admissions and between 15000 and 22000 deaths per annum in the United Kingdom [1]
Summary
There exists a wealth of evidence regarding the detrimental impact of hazardous alcohol consumption, consuming more than the weekly recommended number of standard alcohol units in any week (21 for males, 14 for females) or half of the recommended number of standard alcohol units in any one day (10 for males, 7 for females), on the physical and mental health of the population. Recent research using data derived from the General Practice Research Database indicates that only 5% of people aged 55 years or older with an alcohol use disorder are identified in primary care settings [13]. Studies have demonstrated the effectiveness of brief interventions in reducing alcohol consumption in primary care populations in the United Kingdom [21]. In a trial of brief interventions for older alcohol users in primary care in the United States, Fleming et al [28] reported a 34% reduction in alcohol consumption and 64% reduction in those drinking at hazardous levels at 12 months, significantly better than those who received no intervention. The evidence of brief interventions has been criticised for failing to address a wider range of alcohol use disorders including harmful alcohol consumption [32] and for failing to address more entrenched drinking behaviours. To study the process of therapy as delivered by both practice nurses and trained therapists
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
