Purpose: Alcohol use is the second greatest risk to health in developed countries. Heavy consumption increases the risk of health problems and mortality. Trends towards increased consumption are therefore a matter of concern. In many developed countries, increases over recent years in alcohol consumption and related problems have been reported among older age groups. Frequent alcohol consumption can also have a negative impact on health, and is positively associated with age: in the UK 28% of men and 14% of women over 65 years drink more than five times per week. Older people are more likely than younger adults to suffer from chronic health problems, bereavement or isolation and to use medications, which may interact with alcohol. Heavy drinking in this age group has been found to be positively associated with symptoms of depression and anxiety and less social support. Encroaching health or social problems can lead to increased alcohol consumption to self-medicate or to cope. For these reasons, drinking can have a greater impact on health in older individuals compared to younger adults, and can have an effect at lower levels of consumption than would be the case in middle age or early adulthood.
Design/Approach: The original study aimed to carry out a needs assessment of older people and alcohol use across South of Tyne and Wear (South Tyneside, Gateshead and Sunderland) and to make recommendations for future service provision. The study involved the following distinct phases, a literature review, a service mapping exercise, qualitative interviews (12 men, 12 women) and three focus groups (6 men, 21 women) with older people, questionnaire survey of Age UK members and interviews with key informants.
Findings: Older people are one of the least well informed groups about alcohol units and there is little evidence regarding the effects of education campaigns. Older people have been shown to be as likely to benefit from treatment as younger people and to follow treatment regimens more diligently. However, only a small proportion of older people with alcohol problems are referred on for treatment. Brief interventions have been shown to be effective at reducing alcohol consumption among older adults. Inpatient (rather than outpatient) detoxification is recommended for older people who are severely alcohol dependent, although information on the use of abstinence medication in older people is limited.
Forty six service providers were identified across the South of Tyne Primary Care Organisation area, 33 provided interventions within Tier 1, nine within Tiers 2 and 3, and four within Tier 4 of the Models of Care for Alcohol misusers (MoCAM) specifications. Turning Point in Gateshead was the only service identified as providing a specific intervention for older people with alcohol related problems.
Alcohol was associated with sociability, relaxation and forgetting troubles. Bereavement and loss of work were seen as triggers to heavier drinking. Problematic drinking usually took place at home and alone, in response to isolation, boredom or to relieve a wide range of mental or physical symptoms; most participants were on some medications. Older people tend to look first to their GP for advice or help with alcohol, but may find it difficult to overcome perceived stigma around alcohol dependence. Detoxification courses were found effective but in the short term; rehabilitation facilities were appreciated but seen as difficult to access. Differing opinions were held about the usefulness of counselling and self-help groups; activities, informal groups and drop-in centres were endorsed as less demanding facilities that provided a comforting and supportive environment and a distraction from drinking.
A convenience sample of 146 Age UK (South of Tyne and Wear) members completed the Alcohol Use Disorders Identification Test (AUDIT). The vast majority of this sample of older individuals consumed alcohol and most did so in a sensible fashion. Only 6% of the sample scored positive for risky alcohol consumption according to AUDIT. However 21% had also experienced episodes of binge drinking. Men were more likely to be risky drinkers when compared to women.
Project Award: £36,696.00
Funder: Age UK South of Tyne and Wear
Project dates: From 1 July 2009 to 1 September 2010
Practical implications: This pilot work can and will be built upon in order to establish the most cost effective interventions to reduce alcohol consumption in older people. It is intended that a theory and evidence based intervention will be developed to reduce alcohol consumption in older people. The cost-effectiveness of such an intervention to reduce alcohol consumption in older people will be demonstrated.
Purpose: Diabetes is a progressive disease with debilitating complications including eye, kidney, nerve and cardiovascular disease. It is the main cause of blindness in adults of working age. The prevalence of diabetes is rapidly increasing and is estimated to reach around 10% of the UK adult population by 2030. Diabetes treatment costs to the NHS are currently about £8.8 billion a year and expected to reach £17 billion by 2035. Up to 90% of the diabetes in UK adults is type 2 diabetes. Type 2 diabetes is highly prevalent in UK populations of South Asian, Chinese, African Caribbean and Black African descent and people from these groups tend to develop type 2 diabetes at younger ages than do people from the white population. Although there is a genetic predisposition for type 2 diabetes it is essentially a lifestyle disease and the increasing prevalence is linked to the obesity epidemic. There is evidence from large well conducted trials that type 2 diabetes can be prevented by lifestyle intervention. Increased physical activity, a healthy diet, with increased consumption of fibre and reduced fat consumption, and weight loss can reduce the risk of developing type 2 diabetes. NICE guidance for risk identification and interventions for type 2 diabetes prevention in high-risk individuals was published in July 2012.
Design/Approach: The ‘New life, New you’ behavioural intervention for diabetes prevention was developed with evaluation embedded from the start. We published the results of the first ‘New life, New you’ feasibility study in 2013. People of black and minority ethnic populations were not excluded from participating in the original intervention, but only two people from these groups joined the programme. Subsequently a cultural adaptation of the ‘New life, New you’ intervention was commissioned and developed, also with embedded evaluation. This programme aimed to recruit people from the local black and minority ethnic populations, assess their type 2 diabetes risk and engage those at increased risk of type 2 diabetes in the adapted lifestyle intervention to increase physical activity and promote healthy eating, with weight loss for those overweight.
Findings: Between May 2012 and April 2013, 188 women were recruited to the programme with baseline mean (SD) variables: FINDRISC score 13.9 (3.2); age 38.7 (10.5) years; weight 76.8 (15.0) Kg; and waist circumference 101.2 (11.8) cm. The majority ethnic groups recruited were Pakistani (n=132 (70%)) and black African (n=25 (13%)). Twelve months of follow-up was completed by 121 (64%) of women with change (95% CI) in weight -2.5 (-1.3 to -3.7) Kg, waist circumference -6.6 (-5.0 to -8.1) cm and self-report PA 1.0 (-0.6 to 2.7) MET hours/day equivalent. The programme delivered to men from black and minority ethnic populations has been less successful and development work from this programme is ongoing.
Funder(s): The cultural adaptation of ‘New life, New you’ for black and minority ethnic populations in Middlesbrough is funded by Middlesbrough Council. The original ‘New life, New you’ intervention was funded as a 2012 Olympic Legacy Project by a consortium including: Sport England, Middlesbrough Council and the NHS in Middlesbrough.
Acknowledgements: We thank all the participants in the culturally adapted version of the ‘New life, New you’ intervention for black and minority ethnic populations in Middlesbrough. In particular we wish to thank those participants who contributed to the qualitative interviews. We thank the project commissioning team from Middlesbrough Local Authority, Public Health and the intervention delivery staff.
Project dates: From 1 April 2012 to date
Practical implications: A report was sent to the commissioners in June 2014. The cultural adaptation of the ‘New life, New you’ intervention for women is retained as a service provision locally and the men’s programme is being further developed. The feasibility study with associated qualitative evaluation(s) will be widely disseminated and used to further develop the service. We have supplied the findings from both the original and the culturally adapted versions of the ‘New life, New you’ interventions to both the NICE guidance review of NICE PH38 (Preventing type 2 diabetes: risk identification and interventions for individuals at high risk) and the reviews being conducted for the new NHS and PHE National diabetes prevention programme initiative.
Purpose: Older people in poor health are more likely to need extra money, aids and adaptations to allow them to stay in their homes and remain in good health, yet many do not claim the benefits to which they are entitled.
This study will evaluate the effects on health and wellbeing of a welfare rights advice service provided by social services departments in north-east England for low income older people, who we will identify from general practices.
Design/Approach: Seven-hundred-and-fifty-five (755) older people have volunteered to take part and have been assigned, by chance, to one of two groups. Half of the volunteers have been given an appointment with a welfare rights advisor in their own home, during which they received a full benefit assessment and help with claiming benefits and other entitlements. Advisors kept in touch with them until they no longer needed help. The remaining older people will receive exactly the same help and advice 24 months later and usual care in the meantime. Older people in both groups were interviewed at the outset and will be interviewed again after 24 months to find out whether the service has had beneficial or other effects and whether it is acceptable. We will also assess whether the service offers good value for money and is acceptable to professionals. Older people in both groups will be free to seek advice independently or to leave the study at any time.
Findings: Study recruitment started in May 2012 and the study is expected to report in late 2015. Seven-hundred-and-fifty-five (755) participants have been recruited and, so far, 85% of them have responded to a brief follow-up questionnaire 12 months after recruitment to the study. Final follow-up will commence in May 2014.
Project Award: £764,894.00
Project dates: From 1 December 2011 to 1 December 2015
Practical implications: The study will have implications for fundamental understanding of social inequalities and how to tackle them, and provides a model for similar evaluations of health-orientated social interventions. If the health benefits of this intervention are proven, targeted welfare rights advice services should be extended to ensure widespread provision for older people and other vulnerable groups.
Contact information: Principal Investigator: Professor Martin White
Please direct all queries to Lavinia Micelli, project secretary, Newcastle University, email: email@example.com
Related project pages: NIHR PHR project portfolio