What Works for Older Adults to Reduce Problematic Alcohol Use: A Delphi Study on Elements and Mechanisms in...

Understanding elements for older adults to reduce their problematic alcohol use is important for the development of interventions. This study aimed to establish expert consensus on effective and applicable elements, including their underlying mechanisms to reduce problematic alcohol use; and explore which elements are most effective and which mechanisms are important for older adults with lower- and higher-severity problematic alcohol use, resulting in a programe theory.

A three-round questionnaire-based Delphi study was conducted in the Netherlands. In the first (n = 20) and second round (n = 18), experts with treatment, research, policy, intervention development, educational and lived experience, rated 85 elements on their effectiveness and applicability, and mechanisms on exploratory power. In the third round (n = 18), 40 elements and 39 mechanisms with consensus were ranked on effectiveness and importance.

The most effective and applicable elements with consensus were addressing age-related issues and the combination of drinking and smoking; using motivational interviewing techniques; having an empathic, supportive and listening practitioner; and having therapeutic alliance. Mechanisms best explaining the elements' effectiveness were enabling early identification and timely intervention, and feeling recognised and acknowledged in group interventions. For older adults with lower-severity problematic alcohol use, insight into their use was particularly important, whereas for those with higher-severity, self-efficacy was important.

Elements and mechanisms related to motivation, personalisation, lifestyle, life stage, and relational connections with practitioners and/or group members were found particularly effective and important. The programe theory can inform the development of interventions for older adults with problematic alcohol use.