A Narrative Review of Alcohol Prevention Interventions Among Older Adults.

purposeAlcohol use and alcohol use disorder (AUD) among adults age 50 and older are an expanding public health challenge, requiring effective alcohol prevention interventions. Empirical literature on prevention interventions among older adults is limited by design issues, lack of publication, and misconceptions of aging. To enhance scientific rigor, prior reviews of prevention interventions among older adults excluded pre-to-posttest studies and studies with subgroups, such as veterans, racial minorities, and individuals who seek out digital interventions. The current narrative review aims to understand with whom prevention interventions for older adults are tested; describe barriers and facilitators of successful interventions; and include perspectives of both older adults and intervention providers. Unlike prior reviews, it includes a range of study designs, including digital interventions, and examines decade of age, periods in which studies took place, and generational factors associated with prevention intervention success. SEARCH

methodsIn December 2024, Boolean search terms, such as "alcohol*," "older adults," and "intervention," were used across medical and social science databases, including PubMed, World of Science, PsycInfo, Social Sciences Citation Index, Cochrane Database, and other sources. The searches identified 983 articles published between 1999 and 2024, 582 of which were duplicates. Of the 401 abstracts reviewed, 231 did not mention older adults and/or alcohol. Thus, 170 full texts were reviewed. To be included, studies had to be peer-reviewed; have a mean participant age of 55 and older or a labeled subsample of individuals age 50 and older; focus on a nonpharmacological intervention; and reported alcohol or alcohol-related outcomes or older adult and/or provider perspectives of interventions. Studies set in a formal substance use treatment program were excluded. Overall, 84 records describing 51 interventions and 16 articles of consumer and provider perspectives were synthesized. SEARCH

resultsStudies were categorized into primary prevention, secondary prevention of AUD, and tertiary prevention of worsening AUD. Most interventions were delivered in person, in primary care, with individuals born from 1901 to 1923 (Greatest Generation) and 1924 to 1945 (The Silent Generation), and yielded significant reductions in alcohol use and related consequences. Only The Silent Generation consistently responded to interventions, demonstrating large effects. Additionally, two out of 18 randomized controlled trials found that individuals born from 1946 to 1964 (Baby Boomers) significantly responded to prevention interventions. Digital interventions were successful across generations. DISCUSSION AND

conclusionsBarriers to successful interventions occur at the organizational, provider, and older adult levels. Prevention intervention facilitators include drink tracking, agreement with another person, and aligning tone of the intervention to older adult perspectives of their drinking and perceived need to change. Adapting prevention interventions to older adults could include tailoring to an individual's identity, culture, and meaning behind their drinking, which is often defined by generation, rather than only by age.