Systematic review and comparison of qualitative syntheses of older adults and associated health and social care workers’ views of drinking in later life

Problem

Later life drinking is associated with substantial risks to health and wellbeing. Comorbidities and polypharmacy are increasingly common with age, and can combine with alcohol to generate adverse consequences for older adults’ health. Current cohorts of older adults are likely to have been regular, lifelong drinkers, and historical alcohol consumption may begin to affect health as the individual enters later life. Consequently, alcohol policy and practice has begun to focus on this age group. Health and social care workers might be expected to intervene with older people’s potentially problematic drinking, but evidence suggests that later life drinking is often overlooked. The reasons for this are unclear, but professionals’ understanding of the meaning of alcohol in older adults’ lives is likely to be important. This study aims to explore discrepancies in perceptions of drinking in later life between health and social care workers and their older clients.

Approach

Using systematic review methodology, it draws on existing qualitative studies to explore and synthesise the perceptions and experiences of a) older adults and b) health and social care workers surrounding non-dependent drinking in later life. Medline, PsychINFO, Scopus, ASSIA and CINAHL databases were systematically searched for qualitative articles. References and citations of included articles were checked, as were relevant journals. Of 2055 unique articles, 24 studies were identified examining older adults’ perceptions, and 19 studies were identified examining health and social care workers’ perspectives. Older adults’ and health and social care workers’ perspectives were synthesised separately in two qualitative analyses applying the principles of thematic synthesis. Disparities between the two perspectives are examined by contrasting the findings of the two syntheses.

Findings

Older adults emphasised the role of drinking in their social lives and leisure time. Positive effects of drinking for health were highlighted. Whilst some negative consequences of drinking were described, older people tended to dichotomise their drinking from ‘problematic’ drinking and saw themselves as responsible drinkers. Consequently, many felt that they were protected from the negative effects of drinking on health. In contrast, health and social care workers noted the effects that non-dependent drinking could have on the health of their older clients. They note limitations in the knowledge and beliefs of older people surrounding drinking guidelines and the effects of alcohol. Some roles of drinking are presented, but these are associated with providing continuity and coping with loss in later life.

Consequences

By contrasting these perspectives, we present an insight into how discrepancies in perceptions can present issues in practice. This review and comparison of syntheses provides a timely input into understanding issues in discussing alcohol use in a clinical setting given the recent changes in UK drinking guidelines, at a time when many are recommended to reduce their drinking.