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"Ageing with an alcohol problem is not what I envision": reclaiming agency in shaping personal ageing trajectory and recovery from alcohol problems
Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). The Swedish National Graduate School for Competitive Science On Aging and Health (SWEAH), Faculty of Medicine, Lund University, Lund, Sweden.ORCID iD: 0000-0002-4378-6803
Umeå University, Faculty of Social Sciences, Department of Social Work.ORCID iD: 0000-0003-3452-3953
Umeå University, Faculty of Social Sciences, Department of Social Work.ORCID iD: 0000-0003-0108-4237
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0002-9976-5227
2023 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 23, article id 866Article in journal (Refereed) Published
Abstract [en]

Background: Eliciting and understanding older persons’ descriptions of their resources for healthy ageing and the interaction of these resources with alcohol use and alcohol problems can facilitate health promotion. It can also inform clinicians when identifying areas of recovery capital that present risks and strength for older people seeking alcohol treatment. The objective of this study was to illuminate the experiences and perspectives of older persons on ageing, alcohol use, treatment, and recovery from alcohol problems, as well as their understanding of healthy ageing.

Methods: Eight men and two women, aged 61 to 73 years, with moderate drinking as a treatment goal and treated at an outpatient alcohol clinic in Sweden, participated in semi-structured audio-recorded virtual interviews. A qualitative content analysis examined the transcribed interviews.

Results: Three themes were identified: “Tipping the balance”, “Staying behind a veil” and “Lifting the vail”. First, participants understood healthy ageing as a personal and multidimensional process that involved actively expanding, maintaining or adjusting to the resources needed to lead an active and meaningful life while preserving autonomy, dignity and independence for as long as possible. Second, most participants viewed moderate alcohol use as a contributor to healthy ageing. They sought treatment when their drinking became unsustainable and an immediate threat to their healthy ageing resources. Stigma, ambivalence and a lack of treatment options, however, contributed to delayed treatment. Third, the participants responded to treatment approaches that elicited their concern, incorporated their expertise and treatment and life goals, appreciated their autonomy and agency, and considered them partners in goal setting and decision making. Reduced drinking helped participants regain their agency and improved their healthy ageing capital which in turn catalyzed continuing recovery.

Conclusions: Older persons in non-abstinent recovery perceive healthy ageing and alcohol recovery as personal and interacting multidimensional processes involving their agency to improve biopsychosocial functioning. Treatment approaches that recognize older persons’ desire for healthy ageing, incorporate their treatment goals and respect their autonomy are likely to be acceptable and effective.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023. Vol. 23, article id 866
Keywords [en]
Alcohol use disorder, Healthy aging, Aged, Quality of life, Recovery, Stigma, Alcohol treatment, Person-centered care, Alcohol
National Category
Psychiatry Geriatrics Substance Abuse Social Work Gerontology, specialising in Medical and Health Sciences Psychology
Research subject
medical behavioral science
Identifiers
URN: urn:nbn:se:umu:diva-205173DOI: 10.1186/s12877-023-04573-yScopus ID: 2-s2.0-85179992364OAI: oai:DiVA.org:umu-205173DiVA, id: diva2:1739496
Projects
Substance Use Disorder Among Older Adults: typologies, pathways and health outcomes
Funder
The Kempe Foundations, 2022-04-26The Royal Swedish Academy of Sciences, SO2021-0027Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-07213Available from: 2023-02-25 Created: 2023-02-25 Last updated: 2023-12-28Bibliographically approved
In thesis
1. Alcohol and aging: a multimethod study on heterogeneity and multidimensionality
Open this publication in new window or tab >>Alcohol and aging: a multimethod study on heterogeneity and multidimensionality
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Alkohol och åldrande : en multimetodstudie om heterogenitet och multidimensionalitet
Abstract [en]

Background and Objectives: With an ageing population, the number of older persons with substance use problems, particularly problematic alcohol use, is increasing. Despite grow­ing recognition of the negative consequences of problematic alcohol use on older persons, there is a dearth of knowledge about the alcohol use profiles and the dimensionality of alcohol problems in older people. Moreover, little is known about older persons’ experi­ences and perspectives on alcohol use in relation to their ageing and their personal goals regarding treatment and recovery. This thesis aimed to (i) describe the characteristics of older persons who accessed municipal substance use treatment and care services (addic­tion services) and to investigate their future hospitalization; (ii) examine the heterogeneity and multidimensionality of problematic alcohol use among older persons; and (iii) to shed light on the experiences and perspectives of older persons regarding ageing, alcohol prob­lems and recovery.

Methods: For studies I-III, municipal Addiction Severity Index (ASI) assessment data (between 2003 and 2017) from adults aged 50 years and older were used to select the study samples. Generalized linear regression models investigated hospitalization related out­comes among 3624 older persons in Study-I. In Study-II, a latent class analysis was applied on ASI data from 1747 individuals with alcohol problems. Study-III linked the ASI data from Study-II to hospital discharge and mortality data forming time-to-repeated-event dataset; Andersen-Gill regression model with a robust variance estimator was used for the analysis. Study-IV applied qualitative content analysis on interview data from ten older persons re­cruited from a specialist outpatient clinic for alcohol treatment. 

Results: Nearly three-fourth of older persons assessed for substance use severity at municipal addiction services were later hospitalized (Study-I). Individuals diagnosed with substance use disorders, psychiatric or dual diagnoses had more cumulative hospitalized days, higher rates of hospital readmissions, and shorter time to first admission following an initial ASI assessment at municipal addiction services (Study-I). Five distinct groups of older persons with comparable alcohol problem severity but with variation in onset age, psychiatric comorbidities, polysubstance use, social support and gender composition were identified (Study-II). The five groups varied in risks of repeated hospitalizations due to substance use and psychiatric disorders (Study-III). Older persons experienced their ageing and alcohol use having a dynamic interplay (Study-IV). They needed to constantly negotiate with their environment to maintain a positive ageing trajectory. They perceived moderate alcohol use fosters healthy ageing, but over time, experienced their alcohol use as unsustainable and a threat to their pursuit of healthy ageing. Stigma and ambivalence delayed treatment seeking (Study-IV). They accessed treatment programs which re­spected their preferences and autonomy, engaged them in goal setting and strengthened their agency. After reducing their alcohol use, positive changes in their biopsychosocial functioning encouraged them to continue their recovery journey even in the presence of setbacks (Study-IV).

Conclusion: Most older persons who access municipal addiction services are hospitalized repeatedly. Many older persons with alcohol problems live with medical and psychiatric comorbidities suggesting multiple care needs from health and social care services. Incor­porating older persons’ desire for healthy ageing into alcohol treatment plan can facilitate treatment engagement and recovery. Many older persons aim to moderate their alcohol consumption. Clinicians can deliver person-centered care for older persons, by consider­ing their heterogeneity in treatment goals, biopsychosocial functioning, and available re­sources. A multidimensional identification of alcohol use profiles could improve treatment by establishing the variation in alcohol problems among older treatment seekers. Older persons stay engaged in alcohol treatment programs which value their experiences and expertise, incorporate their personal treatment and life goals, respect their autonomy and agency, and involve them as active participants. Sensitizing service providers on old age substance use problems could provide multiple points of contact for screening of older persons and earlier referral to treatment. A streamlined data sharing within and between health and social care services fosters timely and equitable care and facilitates an inte­grated and person-centered care across the continuum. 

Place, publisher, year, edition, pages
Umeå: Umeå University, 2023. p. 98
Series
Studier i socialt arbete vid Umeå universitet : avhandlings- och skriftserie, ISSN 0283-300X ; 100
Keywords
older adults, substance use disorder, alcohol use disorder, comorbidity, recovery, alcohol treatment, aging, healthy aging, integrated care, person-centered care, biopsychosocial model, register-based, longitudinal, latent class
National Category
Substance Abuse Gerontology, specialising in Medical and Health Sciences Social Work
Research subject
medical behavioral science; health services research; health services research; Psychiatry
Identifiers
urn:nbn:se:umu:diva-205174 (URN)978-91-8070-010-8 (ISBN)978-91-8070-009-2 (ISBN)
Public defence
2023-03-24, Hörsal UB.A.220 (Lindellhallen 2), Umeå, 13:00 (English)
Opponent
Supervisors
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-07213The Royal Swedish Academy of Sciences, SO2021-0027The Kempe Foundations
Available from: 2023-03-03 Created: 2023-02-25 Last updated: 2023-02-27Bibliographically approved

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Jemberie, Wossenseged BirhaneSnellman, FredrikEriksson, Malin

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