Project partners (charities, Universities, NHS trusts, care providers etc): University of Southampton, University Hospital Southampton NHS Foundation Trust

Full team listing including PPI

Professor Julia Sinclair – Chief Investigator

Professor Jackie Bridges – Co-applicant

Dr Becky Band – Co-applicant

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

Summary 

Alcohol use disorders (AUD) in older adults is a growing problem which is currently under-recognised and under-treated. With little research into this area, there is no in-depth understanding about the factors that may contribute to AUD in older adults, nor the lived experiences of this group. Some have suggested that factors such as social isolation, loneliness and loss associated with older age may be important in understanding alcohol use. We know that in general, limited social contact and loneliness have a negative impact on both mental and physical health.

One way to understand the amount and types of social connections someone has is to map their personal social network. This might include a whole range of people such as important family, friends, neighbours and acquaintances, pets, community places, groups or activities. This helps people to think about who is important in their daily lives, the roles that different relationships play, how this might have changed over time and how this might be improved, for example, by exploring ways to obtain additional support in the future.

In this study we will invite older adults who have participated in a linked study to take part in an interview. The linked study will follow-up older adults with AUD for 6 months after being admitted into hospital. The people invited to this study will be selected based on lots of different factors, such as their age, how many people they live with, or how lonely they are, to ensure we are able to capture a variety of experiences within this group. Only those who have given permission to be contacted will be approached.

The interviews will be 1:1 with a researcher and might happen in person, over the phone or through an online video call. Participants will first be guided through the process of mapping their current social network with the researcher. The interview will then discuss the support received from the person’s social network, as well as talking about the participants’ daily lives (including daily routines, physical and mental wellbeing and valued activities) and additional support needs. Interviews will last around 1 hour. They will be audio-recorded, transcribed and anonymised before analysis.

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 did we do with this?

• 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.

What's next?

We have formed a stakeholder group to discuss our findings and what the most appropriate next steps should be.

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.