Health promotion and primary disease prevention among older adults have received increasing attention as a larger proportion of the U.S. population reaches late life. Targeted early identification and secondary prevention programs for the elderly have been developed and shown to be effective in areas as diverse as cancer, heart disease, smoking, an diet. Alcohol problems among the elderly have been largely ignored in these efforts. There is emerging evidence, however, that problem drinking in late life affects a larger proportion of the elderly population than previously thought. Early identification and secondary prevention using """"""""brief"""""""" or minimal intervention strategies have been demonstrated to be effective in reducing alcohol problems among younger individuals. It remains to be seen whether such brief interventions program can be effectively implemented with older problem drinkers. This study, presenting a continuation of ongoing research at the UMARC, will study this issue using a broad range of outcomes among a diverse population of older adults. In a natural extension of the Screening and the Psychosocial Risk Factors Major Research Components conducted during the first project period of the UMARC, this study has two major objectives: (1) develop an age-specific brief intervention for older problem drinking that can be used in primary care settings, and (2) evaluate the effectiveness of the brief intervention for a heterogeneous sample of older problem drinkers, including those with a range of alcohol involvement, of both genders, and involving both Caucasians-Americans and African-Americans. Utilizing a valid and reliable elder-specific screening instrument (MAST-G) developed at the UMARC specifically to identify older problem drinkers, this randomized controlled trial will contrast the brief intervention to a """"""""no-treatment"""""""" control condition. Subjects will be identified through screening approximately 5000 older patients in primary care practice settings located in urban, suburban and rural locations in Southeastern Michigan. Following screening, 300 older problem drinkers stratified by gender will be randomly assigned to receive either [1] a brief elderly-specific intervention to stop drinking, or [2] no intervention. Randomized study subjects will be re- contacted at 3, 6, 12 and 24 months. Effectiveness of the brief intervention will be measured by reduction in frequency and quantity of alcohol use, problem consequences associated with drinking, and improvements in levels of psychological distress and social and physical functioning. Analyses will test intervention effects overall and differential effects be severity of problem drinking, gender, duration of problematic alcohol use, and passage of time since intervention. Results of the study should provide critical information about the effectiveness of brief intervention strategies for a range of drinking problems in older adults, potentially leading to implementation of broadly-based, cost-effective screening and interventions in primary care settings.
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