Managing older people's perceptions of alcohol-related risk: a qualitative exploration in Northern English primary care

GPs' experiences of phosphatidylethanol in treatment of hypertension: a qualitative study

BACKGROUND

Hazardous alcohol use increases the risk of hypertension but is underdetected in primary healthcare (PHC) patients. Use of the biomarker phosphatidylethanol (PEth), which reflects the last 2-3 weeks of alcohol consumption, is increasing in Swedish PHC, but studies exploring its use for hypertension are scarce or missing.

AIM

To explore GPs' experiences of using PEth to identify hazardous alcohol use in the context of managing hypertension.

DESIGN & SETTING

A qualitative study of GPs (n = 12) experienced in using PEth in hypertension management who were recruited at Swedish primary healthcare centres (PHCC) in 2021.

METHOD

The GPs participated in five focus group interviews. A questioning route was used. The interviews were audio-recorded, transcribed verbatim, and analysed with inductive qualitative content analysis.

RESULTS

'I don't hesitate anymore' was the overall theme, which reflected both the disappearance of GPs' fear that the PEth result might upset the patient, as this rarely occurred, and that the positive effects of PEth predominated in the findings. The theme is underpinned by the following four sub-themes: serving as an eye-opener; improving the dialogue; using with care; and learning by doing.

CONCLUSION

PEth is a useful tool that changed GPs' routines for addressing alcohol and identifying hazardous alcohol use in patients with hypertension managed in PHC. The GPs advocated adopting PEth as a routine test in the treatment of hypertension. However, PEth needs to be used with care to maximise benefit and minimise harm.

Self-management with alcohol over lifespan: psychological mechanisms, neurobiological underpinnings, and risk assessment

Self-management includes all behavioural measures and cognitive activities aimed at coping with challenges arising throughout the lifespan. While virtually all of these challenges can be met without pharmacological means, alcohol consumption has long been instrumentalized as a supporting tool to help coping with problems arising selectively at adolescence, adulthood, and ageing. Here, we present, to our knowledge, the first systematic review of alcohol instrumentalization throughout lifespan. We searched MEDLINE, Google Scholar, PsycINFO and CINAHL (from Jan, 1990, to Dec, 2022) and analysed consumption patterns, goals and potential neurobiological mechanisms. Evidence shows a regular non-addictive use of alcohol to self-manage developmental issues during adolescence, adulthood, and ageing. Alcohol is selectively used to overcome problems arising from dysfunctional personality traits, which manifest in adolescence. A large range of psychiatric disorders gives rise to alcohol use for the self-management of distinct symptoms starting mainly in adulthood. We identify those neuropharmacological effects of alcohol that selectively serve self-management under specific conditions. Finally, we discuss the adverse effects and associated risks that arise from the use of alcohol for self-management. Even well-controlled alcohol use adversely impacts health. Based on these findings, we suggest the implementation of an entirely new view. Health policy action may actively embrace both sides of the phenomenon through a personalized informed use that allows for harm-controlled self-management with alcohol.

Experiences of alcohol-dependent elderly: grounded theory

OBJECTIVE

To interpret the experiences of alcohol-dependent elderly people.

METHOD

Qualitative research developed through the theoretical and methodological assumptions of the Grounded Theory in the Straussian version. It was carried out in a small town in the mid-western region of the state of São Paulo. The selection was by theoretical sampling, totaling 25 participants from three sample groups. Semistructured interviews were conducted from March 2019 to January 2020.

RESULTS

The phenomenon "Experiencing alcohol dependence in old age", is conditioned by the category "Initiating Alcohol Consumption", are actions/interactions "Justifying alcohol consumption" and "Coping with alcohol treatment and abstinence" whose consequences are "Experiencing the harms of alcohol dependence" and "Expressing feelings".

CONCLUSION

It was evidenced that the elderly participants consider alcohol dependence as a way to deal with negative emotions, and, in this trajectory, they experience physical, mental, and social consequences. The elderly in abstinence express feelings of loneliness, regret, and desire for a life with quality, and indicate that behavioral change occurs through treatment and awareness of its harmful effects.

Vivências de idosos dependentes de álcool: teoria fundamentada nos dados

RESUMO Objetivo: Interpretar as vivências dos idosos dependentes de álcool. Método: Pesquisa qualitativa desenvolvida por meio dos pressupostos teórico-metodológicos da Teoria Fundamentada dos Dados na versão straussiana. Foi realizada em um município de pequeno porte da região centro-oeste paulista. A seleção foi por amostragem teórica, totalizando 25 participantes a partir de três grupos amostrais. Foram conduzidas entrevistas semiestruturadas entre março de 2019 a janeiro de 2020. Resultados: O fenômeno “Vivenciando a dependência de álcool na velhice”, está condicionado pela categoria “Iniciando o consumo de Álcool”, são ações/interações “Justificando o consumo de álcool” e “Enfrentando o tratamento e a abstinência do álcool” cujas consequências são “Experienciando os danos da dependência de álcool” e “Expressando sentimentos”. Conclusão: Evidenciou-se que os idosos participantes consideram a dependência de álcool como forma de lidar com emoções negativas, e, nessa trajetória, experienciam consequências físicas, mentais e sociais. Os idosos em abstinência expressam sentimentos de solidão, arrependimento e desejo de uma vida com qualidade, e indicam que a mudança comportamental ocorre por meio do tratamento e conscientização de seus malefícios.

Factors affecting primary care practitioners' alcohol-related discussions with older adults: a qualitative study

BACKGROUND

Risk of harm from drinking is heightened in later life, owing to age-related sensitivities to alcohol. Primary care services have a key role in supporting older people (aged ≥50 years) to make healthier decisions about alcohol.

AIM

To examine primary care practitioners' perceptions of factors that promote and challenge their work to support older people in alcohol risk-reduction.

DESIGN AND SETTING

Qualitative study consisting of semi-structured interviews and focus groups with primary care practitioners in Northern England.

METHOD

Thirty-five practitioners (GPs, practice/district nurses, pharmacists, dentists, social care practitioners, and domiciliary carers) participated in eight interviews and five focus groups. Data were analysed thematically, applying principles of constant comparison.

RESULTS

Practitioners highlighted particular sensitivities to discussing alcohol among older people, and reservations about older people's resistance to making changes in old age; given that drinking practices could be established, and promote socialisation and emotional wellbeing in later life. Age-related health issues increased older people's contact with practitioners, but management of older people's long-term conditions was prioritised over discussion of alcohol. Dedicated time to address alcohol in routine consultations with older people and training in alcohol intervention facilitated practitioners, particularly pharmacists and practice nurses.

CONCLUSION

There are clear opportunities to support older people in primary care to make healthier decisions about alcohol. Dedicated time to address alcohol, training in identification of alcohol-related risks (particularly those associated with old age), and tailored interventions for older people, feasible to implement in practice settings, would help primary care practitioners to address older people's alcohol use.