Relatives' perspectives on what works to reduce problematic alcohol use in older adults: A realist evaluation

The rising prevalence of problematic alcohol use among older adults poses challenges to their health and also impacts their relatives. Given the important role relatives play, the objective of this study was to explore their perspectives on working elements (E) and mechanisms (M) within different contexts (C), both within and outside interventions, contributing to the outcome (O) of reducing (problematic) alcohol use among older adults. Guided by a realist evaluation approach, an existing initial program theory (IPT) on working elements in alcohol interventions was tested by conducting interviews with older adults’ partners and family members (N = 14). Data was coded and links between contexts, elements, mechanisms, and outcomes (CEMOs) were sought for to confirm, refute, or refine the IPT. In different contexts, several working elements were identified: (1) paying attention to the causes of use, underlying issues and established patterns, (2) receiving a personalized approach, (3) receiving feedback, (4) having a clear structure in program and meetings, (5) having frequent contact with practitioner and/or peers, (6) hearing the impact of alcohol use on relatives, and (7) relatives’ involvement in interventions and abstinence. Two important mechanisms were having a measure of control and having a deterrent to drink. Both as an addition to the IPT and from the viewpoint of relatives, there is a need to focus on confrontation, involvement of relatives in abstinence and interventions, having structure and contact, and having a measure of control and a deterrent to drink, to reduce problematic alcohol use in older adults.