Working elements in interventions to reduce problematic alcohol use according to older adults: a realist evaluation

Background

Interventions to address problematic alcohol use in older adults are needed as alcohol use is highly prevalent among people over 55 years of age. For interventions to be most effective, their working elements should be leveraged. However, insight into working elements, specifically in interventions for older adults, is limited. This study set out to explore the working elements (E) and mechanisms (M) in interventions within different contexts (C), contributing to the outcome (O), i.e., reducing (problematic) alcohol use among older adults, based on the experience of older adults participating in interventions.

Methods

Guided by a Realist Evaluation approach, an existing Initial Program Theory (IPT) on working elements in alcohol interventions was tested by conducting semi-structured interviews with older adults (N=20). Data was coded and links between contexts, elements, mechanisms and outcomes (CEMO’s), were analysed to confirm, refuse or refine the IPT.

Results 

In different contexts (i.e., with or without practitioner, in person or not, in individual or group setting), several working elements (E) were identified: 1) receiving information about alcohol and health(risks), 2) paying attention to abstinence, 3) being in contact with, and receiving support from peers and relatives, 4) maintaining contact with a professional or peer(buddy) who is always/flexibly available for communication and 5) learning to manage drinking behavior, and one important mechanism (M) was identified: motivation. Findings are in general in line with the IPT, and additional CEMO’s were found. 

Conclusions

Our findings emphasize the need for ‘social contact and support’ from both peers and relatives, ‘tracking and reflecting on alcohol use’, and ‘motivation’ to reduce alcohol use in interventions for older adults. Future research might study the perspective of relatives on working elements and their involvement in interventions.