Development of Australia's first older adult-specific early intervention for alcohol-related harm: Feasibility and proof of concept

Alcohol use and dementia: new research directions

PURPOSE OF REVIEW

Alcohol is gaining increased recognition as an important risk factor for dementia. This review summarises recent evidence on the relationship between alcohol use and dementia, focusing on studies published from January 2019 to August 2020.

RECENT FINDINGS

Epidemiological data continues to yield results consistent with protective effects of low-to-moderate alcohol consumption for dementia and cognitive function. However, recent literature highlights the methodological limitations of existing observational studies. The effects of chronic, heavy alcohol use are clearer, with excessive consumption causing alcohol-related brain damage. Several pathways to this damage have been suggested, including the neurotoxic effects of thiamine deficiency, ethanol and acetaldehyde.

SUMMARY

Future research would benefit from greater implementation of analytical and design-based approaches to robustly model the alcohol use-dementia relationship in the general population, and should make use of large, consortia-level data. Early intervention to prevent dementia is critical: thiamine substitution has shown potential but requires more research, and psychosocial interventions to treat harmful alcohol use have proven effective. Finally, diagnostic criteria for alcohol-related dementia require formal validation to ensure usefulness in clinical practice.

Prevalence of potentially serious alcohol-medication interactions in older adults in a community pharmacy setting: a cross-sectional study

OBJECTIVE

Previous prevalence estimates of POtentially Serious Alcohol-Medication INteractions in Older adults (POSAMINO) are based on in-home inventories of medications; however, this method is associated with under-reporting of medications when compared with dispensing records. This study aims to estimate the prevalence of POSAMINO among community-dwelling older adults using drug dispensing data from the community pharmacy setting.

DESIGN

Cross-sectional study.

SETTING

Irish Community Pharmacy.

PARTICIPANTS

1599 consecutive older adults presenting with a prescription to 1 of 120 community pharmacies nationwide; community-dwelling, aged ≥65 years, able to speak and understand English, with no evidence of cognitive impairment. The mean age of sample was 75.5 years (SD 6.5); 55% (n=884) female.

MEASURES

38 POSAMINO criteria were identified using participants' pharmacy dispensing records linked to self-reported alcohol consumption (beverage-specific quantity and frequency measures) over the last 12 months.

RESULTS

The overall prevalence of POSAMINO in the study population was 28%, with 10% at risk of at least one POSAMINO criteria and 18% at risk of two or more. Exposure to POSAMINO most commonly involved cardiovascular agents (19%) and central nervous system agents (15%). Exposure to a higher number of POSAMINO criteria was associated with younger age (adjusted incident rate ratio (AIRR): 0.97; 95% CI: 0.95 to 0.98), male sex (AIRR: 0.55; 95% CI: 0.45 to 0.67) and a higher number of comorbidities (AIRR: 1.05; 95% CI: 1.01 to 1.13).

CONCLUSION

This study adds to the growing body of evidence, which suggests that older adults are vulnerable to potentially serious alcohol-medication interactions, particularly those involving cardiovascular and central nervous system agents, increasing their risk of orthostatic hypotension, gastrointestinal bleeds and increased sedation. Application of the POSAMINO criteria at the point of prescribing may facilitate the risk stratification of older adults and prioritise alcohol screening and brief alcohol interventions in those at greatest risk of harm.

Evaluation of Australia's first older adult-specific early intervention for reducing alcohol-related harm

The aim of the present case study was to evaluate the service-wide implementation of Australia's first older adult-specific early intervention called Older Wiser Lifestyles (OWL). OWL was designed to reduce alcohol consumption and alcohol-related harm among people identified as being at risk. OWL used the Australian Alcohol-Related Problems Survey (A-ARPS) to classify people's drinking patterns as non-hazardous, hazardous or harmful. Participants of the present study were aged ≥60 years and consumed alcohol in the past month, although they did not require treatment for dependence. The Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) was used as a composite measure of alcohol consumption. Data were collected before intervention and 3 and 6 months after intervention. In all, 140 clients were screened and attended at least one appointment (54% male; mean (± s.d.) age 72.8±7.6 years). Generalised estimating equation (GEE) examined the correlations between the intervention groups, time point and outcomes of interest. At 6 months, significant reductions were observed in A-ARPS classification (P=0.001) and AUDIT-C scores (P=0.001) among all clients, regardless of the number of sessions or intervention group. These preliminary findings warrant a randomised clinical trial of the intervention. Until this is completed, Australian health care providers should still consider the early intervention to reduce the risk of alcohol consumption among older adults.