A qualitative exploration of older adults' and care providers' perceptions of health and psychosocial factors shaping drinking in later life

Abstract

Background: Numerous factors may influence how older people use alcohol. Risks of harm from drinking increase with age, as alcohol affects common health conditions and medications. Drinking can play a positive role in older people’s social lives, and has been associated with some health benefits. Care providers can support older people to make informed decisions surrounding their drinking. However, their work may be affected by their own views about alcohol. Aim: To explore the views of older adults and primary care providers regarding health and psychosocial factors shaping drinking practices in later life, and how these practices are influenced. Methods: A systematic review of qualitative literature examined older adults’ and care providers’ views of drinking in later life, influencing factors and patterns of consumption. In-depth interviews and focus groups were conducted with older adults and primary care providers. Data were analysed thematically, applying principles of constant comparison to conceptualise how health and psychosocial factors shape drinking. Relevant social theory, including Bury’s biographical disruption and Bourdieu’s theory of practice, aided interpretation. Results: Drinking routines developed across the life course, shaped by cultural expectations and norms, and in response to late-life transitions. Drinking played ritualised roles in older people’s social and leisure lives. Older people did not identify with risks of drinking, unless they had explicit reason to believe their intake was damaging. Care providers’ preconceptions surrounding the meaning of alcohol in older people’s lives shaped their approach to discussion. Discussion: Positive roles of alcohol and processes involved in perceiving risk meant associated risks were overlooked by older adults and care providers. Social, routine and moralistic justifications for risky alcohol use must be challenged to address risky drinking amongst older people. Care providers can support older people to recognise risks and develop healthy routines, but require appropriate resources and knowledge.