Evaluation of Australia’s first older adult-specific early intervention for reducing alcohol-related harm

2018 ◽  
Vol 42 (6) ◽  
pp. 676 ◽  
Author(s):  
Stephen J. Bright ◽  
Cylie M. Williams
Keyword(s):  
Older Adults ◽  
At Risk ◽  
Early Intervention ◽  
Alcohol Consumption ◽  
Harm Reduction ◽  
Older Adult ◽  
Health Care Providers ◽  
Care Providers ◽  
Alcohol Related Harm ◽  
Related Harm

The aim of the present case study was to evaluate the service-wide implementation of Australia’s first older adult-specific early intervention called Older Wiser Lifestyles (OWL). OWL was designed to reduce alcohol consumption and alcohol-related harm among people identified as being at risk. OWL used the Australian Alcohol-Related Problems Survey (A-ARPS) to classify people’s drinking patterns as non-hazardous, hazardous or harmful. Participants of the present study were aged ≥60 years and consumed alcohol in the past month, although they did not require treatment for dependence. The Alcohol Use Disorders Identification Test – Consumption (AUDIT-C) was used as a composite measure of alcohol consumption. Data were collected before intervention and 3 and 6 months after intervention. In all, 140 clients were screened and attended at least one appointment (54% male; mean (± s.d.) age 72.8±7.6 years). Generalised estimating equation (GEE) examined the correlations between the intervention groups, time point and outcomes of interest. At 6 months, significant reductions were observed in A-ARPS classification (P=0.001) and AUDIT-C scores (P=0.001) among all clients, regardless of the number of sessions or intervention group. These preliminary findings warrant a randomised clinical trial of the intervention. Until this is completed, Australian health care providers should still consider the early intervention to reduce the risk of alcohol consumption among older adults. What is known about this topic? Older Australians are increasingly drinking alcohol at levels that place them at risk of experiencing harm. Although early interventions have been developed overseas that have been shown to reduce risky drinking among older adults, no such program has been implemented in Australia. What does this paper add? We developed an early intervention program (OWL) that drew from and extended intervention protocols developed overseas. In particular, we added harm reduction as a component of the intervention. Harm reduction interventions do not appear to have been evaluated among older adults. The OWL program was evaluated and found to be associated with decreased levels of alcohol-related harm. What are the implications for practitioners? Older adults have different needs when it comes to considering risk of alcohol-related harm. Many are taking medications that interact with alcohol or have comorbid conditions that can be exacerbated by alcohol or more difficult to treat. Yet, many such individuals are not considered to be at risk due to poor screening among this population. The program we developed takes into account these age-specific factors and has been manualised. As such, it could be implemented by a variety of healthcare workers in numerous settings. We hope that practitioners are interested in trialling the program and that a randomised controlled trial is conducted to establish the efficacy of the program.

scholarly journals Implementation of an Opioid and Benzodiazepine Deprescribing Program for Older Adults in an Outpatient Setting

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 906-906
Author(s):  
Lori Armistead ◽  
Jan Busby-Whitehead ◽  
Stefanie Ferreri ◽  
Cristine Henage ◽  
Tamera Hughes ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
At Risk ◽  
Older Adult ◽  
Adult Population ◽  
Primary Care Providers ◽  
The United States ◽  
Outpatient Setting ◽  
Care Providers ◽  
Risk Of Falls

Abstract The United States spends $50 billion each year on 2.8 million injuries and 800,000 hospitalizations older adults (age 65 years and older) incur as the result of falls. Chronic use of central nervous system (CNS)-active medications, such as opioid and/or benzodiazepine (BZD) medications, increases the risk of falls and falls-related injuries in this older adult population. This Centers for Disease Control and Prevention (CDC)-funded randomized control trial uses electronic health record (EHR) data from primary care outpatient clinics to identify older adult patients at risk for falls due to chronic opioid or BZD use. The primary program aim is to test the efficacy of a targeted consultant pharmacist service to reduce the dose burden of these medications in the targeted population. Impact of this intervention on the risk of falls in this population will also be assessed. Licensed clinical pharmacists will review at-risk patients’ medical records weekly and make recommendations through the EHR to primary care providers for opioid or BZD dose adjustments, alternate medications, and/or adjunctive therapies to support deprescribing for approximately 1265 patients in the first two cohorts of intervention clinics. One thousand three hundred eighty four patients in the control clinics will receive usual care. Outcome measures will include reduction or discontinuation of opioids and BZDs and falls risk reduction as measured by the Stop Elderly Accidents, Death and Injuries (STEADI) Questionnaire. Primary care provider adoption of pharmacists’ recommendations and satisfaction with the consult service will also be reported.

scholarly journals Building a social marketing Strategy to reduce alcohol-related harm in France

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Hochet ◽  
G Quatremère ◽  
R Andler ◽  
C Cogordan ◽  
V Nguyen Thanh
Keyword(s):  
Public Health ◽  
Alcohol Consumption ◽  
Harm Reduction ◽  
Marketing Strategy ◽  
Social Marketing ◽  
The Social ◽  
Set Up ◽  
Alcohol Harm Reduction ◽  
Alcohol Related Harm ◽  
Related Harm

Abstract Background Alcohol use ranks among the top three risk factors in France, leading to about 40 000 deaths annually. French health authorities wished to renew the public health message about alcohol consumption and build a social marketing Strategy to lower the social and health consequences of alcohol consumption in France. Objectives Two main steps were followed: 1) gathering a group of experts to provide up-to-date low-risk drinking guidelines, 2) building, testing and implementing a social marketing Strategy based on this expertise. Results In 2017, the group of experts established low-risk drinking Guidelines based on both scientific evidence and socially acceptable risks for the French population. They suggested to increase awareness on alcohol-related harm as well as on the new Guidelines. In 2018, a social marketing Strategy was set up by Santé publique France, the French national public health Agency. Qualitative and quantitative pretests allowed to develop understandable and potentially effective communication materials consisting of the following message: “To protect your health, no more than 2 alcoholic drinks a day, and not every day”. A web-based brief intervention to assess a person’s alcohol consumption was developed, based on a previous tool whose effectiveness had been demonstrated. In 2019, the Campaign was launched: health professionals were informed at first, followed by a national mass media Campaign that was broadcasted for 3 weeks, targeting the general population (TV, radio, press, the Internet). Conclusions It is the first time in France that such a global Strategy is set up to promote an alcohol harm reduction message. A robust evaluation is in progress but this structured approach seems feasible and reproducible abroad. Key messages In France, an alcohol harm reduction Strategy has been built up and implemented, based on scientifically-established Guidelines. The social marketing campaign is rigorously evaluated to assess its impact and portability.

scholarly journals The Influence of Older Adults’ Beliefs and Attitudes on Adopting Fall Prevention Behaviors

2017 ◽  
Vol 12 (4) ◽  
pp. 324-330 ◽  
Author(s):  
Judy A. Stevens ◽  
David A. Sleet ◽  
Laurence Z. Rubenstein
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Older Adult ◽  
Health Care Providers ◽  
Fall Prevention ◽  
Fall Risk ◽  
Care Providers ◽  
Injury Death ◽  
Effective Interventions ◽  
Control And Prevention

Among Americans aged 65 years and older, falls are the leading cause of injury death and disability, and finding effective methods to prevent older adult falls has become a public health priority. While research has identified effective interventions delivered in community and clinical settings, persuading older adults to adopt these interventions has been challenging. Older adults often do not acknowledge or recognize their fall risk. Many see falls as an inevitable consequence of aging. Health care providers can play an important role by identifying older adults who are likely to fall and providing clinical interventions to help reduce fall risks. Many older people respect the information and advice they receive from their providers. Health care practitioners can encourage patients to adopt effective fall prevention strategies by helping them understand and acknowledge their fall risk while emphasizing the positive benefits of fall prevention such as remaining independent. To help clinicians integrate fall prevention into their practice, the Centers for Disease Control and Prevention launched the STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative. It provides health care providers in primary care settings with resources to help them screen older adult patients, assess their fall risk, and provide effective interventions.

scholarly journals Nurse Practitioners’ Experiences of Polypharmacy in Community-Dwelling Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 207-207
Author(s):  
Christine Pariseault ◽  
Nancy Sharts-Hopko ◽  
Elizabeth Blunt
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Older Adult ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Adult Population ◽  
Medication Management ◽  
Community Dwelling ◽  
Care Providers ◽  
Adequate Care

Abstract Numerous studies exist that define polypharmacy and its impact on health. Additionally, the literature is rich in studies documenting the benefits of care provided by nurse practitioners. A gap in research exists at the intersection of the value of nurse practitioners in caring for older adults and their management of polypharmacy. Coinciding with a growth of America’s older adult population and the need for adequate care, the purpose of this study was to explore the experiences of nurse practitioners caring for older adults experiencing polypharmacy. A qualitative descriptive study was conducted using a purposive sampling of nurse practitioners who care for older adults. Interviews were conducted and data was analyzed for themes. Four themes emerged: defining polypharmacy, communicating and collaborating, clinical judgement of nurse practitioners in relation to polypharmacy, and medication issues of older adults. Major themes emerged that depict the complexity of medication management in older adults as well as the important role of NPs in providing care to older adults. The significance of the study findings to future practice includes improving communication and collaboration of prescribing health care providers, better identification and management of polypharmacy, and improving the health care delivered to older adults. Safe and effective prescribing for older adults requires NPs consider the unique needs of each older adult while utilizing technology to support collaboration and decision making.

Interdisciplinary Therapy Assessments for the Older Adult

2012 ◽  
Vol 17 (1) ◽  
pp. 11-16
Author(s):  
Lynn Chatfield ◽  
Sandra Christos ◽  
Michael McGregor
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Standardized Testing ◽  
Health Care Providers ◽  
Outcome Measurement ◽  
Care Providers ◽  
Patient Centered ◽  
Screening Process ◽  
Evidenced Based ◽  
Changing Economy

In a changing economy and a changing industry, health care providers need to complete thorough, comprehensive, and efficient assessments that provide both an accurate depiction of the patient's deficits and a blueprint to the path of treatment for older adults. Through standardized testing and observations as well as the goals and evidenced-based treatment plans we have devised, health care providers can maximize outcomes and the functional levels of patients. In this article, we review an interdisciplinary assessment that involves speech-language pathology, occupational therapy, physical therapy, and respiratory therapy to work with older adults in health care settings. Using the approach, we will examine the benefits of collaboration between disciplines, an interdisciplinary screening process, and the importance of sharing information from comprehensive discipline-specific evaluations. We also will discuss the importance of having an understanding of the varied scopes of practice, the utilization of outcome measurement tools, and a patient-centered assessment approach to care.

Effects of Cardiovascular Disease and Related Risk Factors on Neurocognition

2019 ◽  
pp. 83-116
Author(s):  
Spencer W. Liebel ◽  
Lawrence H. Sweet
Keyword(s):  
Cardiovascular Disease ◽  
Older Adults ◽  
Cognitive Processing ◽  
Health Care Providers ◽  
The United States ◽  
Research Literature ◽  
Neurocognitive Functioning ◽  
Care Providers ◽  
Cardiac Events ◽  
Related Risk

Cardiovascular disease (CVD) affects approximately 44 million American adults older than age 60 years and remains the leading cause of death in the United States, with approximately 610,000 each year. With improved survival from acute cardiac events, older adults are often faced with the prospect of living with CVD, which causes significant psychological, social, and economic hardship. The various disease processes that constitute CVD also exert a deleterious effect on neurocognitive functioning. Although existing knowledge of neurocognitive functioning in CVD and its subtypes is substantial, a review of these findings by CVD type and neurocognitive domain does not exist, despite the potential impact of this information for patients, health care providers, and clinical researchers. This chapter provides a resource for clinicians and researchers on the epidemiology, mechanisms, and neurocognitive effects of CVDs. This chapter includes a discussion of neurocognitive consequences of CVD subtypes by neuropsychological domain and recommendations for assessment. Overall, the CVD subtypes that have the most findings available on specific neurocognitive domains are heart failure, hypertension, and atrial fibrillation. Despite a large discrepancy between the number of available studies across CVD subtypes, existing literature on neurocognitive effects by domain is consistent with the literature on the neurocognitive sequelae of unspecified CVD. Specifically, the research literature suggests that cognitive processing speed, attention, executive functioning, and memory are the domains most frequently affected. Given the prevalence of CVDs, neuropsychological assessment of older adults should include instruments that allow consideration of these potential neurocognitive consequences of CVD.

HIV/AIDS training for health care providers working with women at risk

1994 ◽  
Vol 18 (2) ◽  
pp. 74-80 ◽  
Author(s):  
Helen Miramontes ◽  
Katie Tom ◽  
Marion Gillen
Keyword(s):  
Health Care ◽  
At Risk ◽  
Health Care Providers ◽  
Care Providers ◽  
Aids Training ◽  
Hiv Aids

Risk factors for glaucoma: what do they really mean?

2011 ◽  
Vol 17 (3) ◽  
pp. 233 ◽  
Author(s):  
Anthea Worley ◽  
Karen Grimmer-Somers
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Risk Factor ◽  
Health Care Providers ◽  
Management Strategies ◽  
Care Providers ◽  
Reference Guide ◽  
Future Assessment ◽  
Primary Health Care Providers ◽  
Patient’S History

Glaucoma is an insidious eye disease, potentially putting 4% of older Australians at risk of blindness, unless detected sufficiently early for initiation of effective treatment. This paper reports on the strengths of evidence and glaucoma risk factors that can be identified by primary health care providers from a patient’s history. A comprehensive search of peer-reviewed databases identified relevant secondary evidence published between 2002 and 2007. Risk factors that could be determined from a patient’s history were identified. A novel glaucoma risk factor reference guide was constructed according to evidence strength and level of concern regarding risk of developing glaucoma. The evidence is strong and consistent regarding the risk of developing glaucoma, and elevated intraocular pressure, advancing age, non-Caucasian ethnicity and family history of glaucoma. There is moderate evidence of association with glaucoma, and migraine, eye injury, myopia and long-term use of corticosteroids. There is conflicting evidence for living in a rural location, high blood pressure, diabetes and smoking. Early detection of people at risk of developing glaucoma can be initiated using our risk factor guide coupled with a comprehensive patient history. Timely future assessment and subsequent management strategies for at-risk individuals can then be effectively and efficiently actioned.

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