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Managing older people’s perceptions of alcohol-related risk – British Journal of General Practice

A Newcastle University study suggests that older people may struggle to recognise risks associated with drinking, unless ill health or screening results indicate that they may be experiencing alcohol-related harm. Primary care practitioners can help, the study reports in the British Journal of General Practice.

Different types of information and experiences affect perceptions of alcohol’s effects among older people, and their decisions on alcohol use.

Older people’s perceptions that their drinking is ‘sensible’, or where their health has become difficult for them to manage, are challenges to be navigated in supporting healthier decisions.

Primary care practitioners can help older people to recognise individual risks and the potential benefits of making healthier drinking decisions to maintain their quality of life.


Alcohol use is a leading modifiable risk factor for illness and premature death. Older adults are at increased risk of harm from drinking at levels that may have been inconsequential earlier in life.

Physiological tolerance of alcohol decreases with age, and older people are more likely to have medical conditions or take medications that are adversely affected by alcohol.

Older people in the UK experience more harm resulting from alcohol use than any other age group. Increasing numbers of older people drink alcohol at hazardous levels, where use could lead to physiological, psychological or social harm.

The role of primary care

Primary care practitioners’ advice is important to inform older people’s decisions about drinking, raising awareness of potential effects on health. Promoting healthier lifestyles and preventing disease are key activities in primary care.

Screening and brief intervention to address hazardous alcohol use are integrated within primary care services, using specific screening tools to identify risks associated with patients’ drinking. Alcohol-related discussion is involved in managing chronic health conditions within primary care.

This work is important in the care of older patients where health status and medicine use determine hazardous levels of intake, and personalised assessment of health risks is crucial. Age-specific screening tools, such as the Alcohol-Related Problems Survey and the Comorbidity Alcohol Risk Evaluation Tool, have been developed for use in primary care to inform tailored advice and are sensitive to individual risks associated with drinking that are common among older people.

Efforts to address hazardous drinking focus on highlighting associated health risks, and providing guidance for low-risk use. Older people’s perspectives of the effects of alcohol on their health are complex, encompassing lay perceptions of protective effects of alcohol, in addition to messages conveyed by practitioners and the media regarding health risks.

Experiences of health consequences from alcohol use influence older people’s decisions to reduce intake. Contributions to wider wellbeing through roles in socialising, relaxing, and coping with stressors also influence their decisions for drinking.

Hazardous drinking

Older people have maintained levels of hazardous drinking in recent years, while the rest of the population have reduced their intake. This suggests public health campaigns and efforts in clinical practice to promote healthier alcohol use have been ineffective in older age groups.  To ensure future practice is responsive to the realities of older people’s decisions about drinking, a good understanding is required of their perceptions of alcohol’s effects on their health, and how these perspectives influence alcohol use. This study focused on understanding perspectives of older drinkers without alcohol dependence.

The majority of people who experience harm from alcohol use are non-dependent drinkers, and their decisions are not dominated by physical dependence on alcohol. Older adults’ views on how alcohol affects their health can be understood through qualitative research.

Primary care practitioners can provide insights into how these perspectives affect older people’s responses to alcohol-related discussions on risk management and behaviour change.

This qualitative study drew on both older people’s and primary care practitioners’ perspectives to examine the following questions:

  • How do older people understand the effects of alcohol for their health?
  • How does their understanding contribute to decisions for alcohol use? and
  • How are older people’s perspectives of alcohol’s effects on their health navigated in primary care discussions to promote healthier use?


Managing older people’s perceptions of alcohol-related risk: a qualitative exploration in Northern English primary care

British Journal of General Practice. Published on 19 October 2020.


Bethany Kate Bareham, Eileen Kaner and Barbara Hanratty

Author affiliation: Population Health Sciences Institute, Newcastle University, UK


Risk of harm from drinking increases with age as alcohol affects health conditions and medications that are common in later life. Different types of information and experiences affect older people’s perceptions of alcohol’s effects, which must be navigated when supporting healthier decisions on alcohol consumption.


To explore how older people understand the effects of alcohol on their health; and how these perspectives are navigated in supportive discussions in primary care to promote healthier alcohol use.

Design and setting

A qualitative study consisting of semi-structured interviews and focus groups with older, non-dependent drinkers and primary care practitioners in Northern England.


A total of 24 older adults aged ≥65 years and 35 primary care practitioners participated in interviews and focus groups. Data were analysed thematically, applying principles of constant comparison.


Older adults were motivated to make changes to their alcohol use when they experienced symptoms, and if they felt that limiting consumption would enable them to maintain their quality of life. The results of alcohol-related screening were useful in providing insights into potential effects for individuals.

Primary care practitioners motivated older people to make healthier decisions by highlighting individual risks of drinking, and potential gains of limiting intake.


Later life is a time when older people may be open to making changes to their alcohol use, particularly when suggested by practitioners. Older people can struggle to recognise potential risks or perceive little gain in acting on perceived risks. Such perceptions may be challenging to navigate in supportive discussions.


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