Lead applicant: Professor Julia Sinclair

Co-applicants: Dr Rebecca Band, Professor Jackie Bridges

Team

Dr Steph Hughes – Research Fellow

Zara Linssen – Medical Student

Sophie Crouzet – Medical Student

Stephen Lim – Implementation Champion

Melinda King – PPI advisor

Start: 01/01/2023

End: 01/07/2024

Partner organisations:

University Hospital Southampton NHS Foundation Trust

University of Southampton

Background

Over 200 physical and mental health conditions are caused by alcohol. In England, more people are being admitted to hospital with, and dying from, alcohol-related disease than ever before.

In 2018/19, 44.7% of all alcohol related admissions were for people over the age of 65 compared with 14% in 2010/11. In 2021,1563 patients were assessed by the Alcohol Care Team (ACT) at University Hospital Southampton, 43% of whom were over the age of 60.

We know that older adults can often feel more shame and stigma related to their alcohol use compared with younger people. This can create barriers to accessing help with existing community addiction services. Beyond this, very little is known about the reasons why older adults drink alcohol and how this may interact with other social factors like loneliness and social isolation. Further research is needed to understand the ways in which to best support older adults to seek help, and what interventions may best promote positive outcomes.  

Study Design

This study will recruit older people with alcohol use disorder (AUD) admitted to hospital in Wessex. A longitudinal observational design will be used, meaning that people in the study will be asked by the research team to complete questionnaires over time following admission into hospital.

This will help to understand the needs of the population.

There will be four main research aims:

1. What are the personal characteristics of older adults with AUD?

2. How do participants make sense of themselves in relation to their alcohol use?

3. What happens to participants in the six months following a hospital admission?

4. What factors what might prevent or encourage people from seeking help for their alcohol use?

Study Methods

The study will identify potential participants through the ACT in Southampton in the first instance. Around 40% of people seen over the age of 65 years. Clinicians working in ACTs have the skills and experience to sensitively identify and assess patients with comorbid alcohol use disorders

Discussion about the study and consent processes will be undertaken by the UHS clinical trials officer. Participants who are willing to be part of the study will complete a set of questionnaires in hospital. Well-established measures of alcohol use, quality of life, loneliness, collective efficacy and health service use will be collected. Participants will be asked to complete similar questionnaires again at 3 and 6 months. This will probably take place over the phone.

Health service use data will be collected for the 6 months after discharge to explore resource use.

Plain English summary of findings

Recruitment to the study was difficult. Many patients who were identified as drinking at increasing or possibly dependent levels did not have mental capacity to take part. Of those who were eligible, a large percentage declined to participate.

This resulted in a small sample size of 30, 16 of which completed their follow-up questionnaire, and 7 interviews. 20% of the sample died during the study window.

Results indicated:

• Over 50% participants showed some level of cognitive impairment

• Participants had an average of 4 people in their social network; usually family members

• Interviews revealed links between social isolation, loneliness and drinking alcohol

• Those who were housebound reported drinking alcohol all day long

• Participants stated alcohol is not, and never has been a problem for them

• 50% participants met the threshold for depression

• Participants often provided conflicting information for the follow-up questions and in the interviews

• Participants had poor diets; of 32 nutrients measured 22 were not consumed in-line with the government recommendations

• 93% participants were taking 5 medications or more

What's next?

• As a small preliminary study the new knowledge has been used to inform future research. Impact on patient care and population health will come from the future research.

• Recruitment was harder than expected. This learning point has informed recruitment and retention procedures in future research applications.

• Other findings, for example, the link described qualitatively between social isolation and increased alcohol consumption, has shaped ideas for intervention development.

We are preparing an application to undertake the planning and developmental work for an intervention aimed at reducing alcohol consumption in a general population of adults aged 65 and over. We plan to test the feasibility of this intervention in a feasibility study.