Assessing the Usability of Web-Based Alcohol Education for Older Adults: A Feasibility Study

Arlene Fink, Lorna Kwan, Dan Osterweil, Jenna Van Draanen, Alexis Cooke, John C Beck, Arlene Fink, Lorna Kwan, Dan Osterweil, Jenna Van Draanen, Alexis Cooke, John C Beck

Abstract

Background: Older adults can experience unfavorable health effects from drinking at relatively low consumption levels because of age-related physiological changes and alcohol's potentially adverse interactions with declining health, increased medication-use and diminishing functional status. At the same time, alcohol use in older adults may be protective against heart disease, stroke, and other disorders associated with aging. We developed "A Toast to Health in Later Life! Wise Drinking as We Age," a web-based educational intervention to teach older adults to balance drinking risks and benefits.

Objective: To examine the intervention's feasibility in a sample of community-dwelling current drinkers ≥55 years of age and examine its effects on their quantity and frequency of alcohol use, adherence to standard drinking guidelines, and alcohol-related risks.

Methods: Participants were recruited in person, by mail and by telephone between September and October 2014 from a community-based social services organization serving Los Angeles County. Once enrolled, participants were randomly assigned to the intervention or to a control group. The conceptual frameworks for the intervention were the Health Belief Model, models of adult learning, and the US Department of Health and Human Services guidelines for designing easy-to-use websites. The intervention's content focuses on the relationship between drinking and its effects on older adults' medical conditions, use of medications, and ability to perform daily activities. It also addresses quantity and frequency of alcohol use, drinking and driving and binge drinking. The control group did not receive any special intervention. Data on alcohol use and risks for both groups came from the online version of the Alcohol-Related Problems Survey and were collected at baseline and four weeks later. Data on usability were collected online from the intervention group immediately after it completed its review of the website.

Results: The 49 intervention and 47 control participants did not differ at baseline in age, ethnicity, medication use, medical conditions, or alcohol use and both groups were mostly female, college-educated, and in good health. Of the intervention participants, 94% (46/49) had little or no difficulty using the website, with 67% (33/49) reporting that they will change the way they think about drinking because of their exposure to the education. At the 4-week follow-up, the intervention group reported drinking less (P=.02). No changes between groups were found in quantity and frequency, adherence to recommended guidelines, or risk status.

Conclusions: Community-dwelling older adults are receptive to online alcohol education. To be most effective, the education should be included as a component of a larger effort consisting of screening and counseling preferably in a health care setting.

Keywords: alcohol; education; elderly; older adults; online alcohol education; web-based.

Conflict of interest statement

Conflicts of Interest: Arlene Fink Associates has received SBIR grants in the area of Web-based alcohol interventions and owns the intellectual property of the application discussed. None of the authors except AF is employed by Arlene Fink Associates, holds equity or stock options or benefits in any other way from the publication of this article. AF owns 100% of Arlene Fink Associates and may benefit from publication of this article. JCB has access to all data and acts as independent guarantor for this study. Other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Screenshot from "A Toast to Health in Later Life! Wise Drinking as We Age". Content for one instructional objective.
Figure 2
Figure 2
Sample question from the Alcohol-Related Problems Survey (ARPS).
Figure 3
Figure 3
Participant flow chart.

References

    1. Schiller J, Lucas J, Peregoy J. Vital and Health Statistics Internet. 2012. [2015-03-20]. Summary health statistics for US adults: National Health Interview Survey, 2011 .
    1. Wilson SR, Knowles SB, Huang Q, Fink A. The prevalence of harmful and hazardous alcohol consumption in older U.S. adults: data from the 2005-2008 National Health and Nutrition Examination Survey (NHANES) J Gen Intern Med. 2014 Feb;29(2):312–319. doi: 10.1007/s11606-013-2577-z.
    1. Adams WL, Cox NS. Epidemiology of problem drinking among elderly people. Int J Addict. 1995;30(13-14):1693–1716.
    1. Moore AA, Gould R, Reuben DB, Greendale GA, Carter MK, Zhou K, Karlamangla A. Longitudinal patterns and predictors of alcohol consumption in the United States. Am J Public Health. 2005 Mar;95(3):458–465. doi: 10.2105/AJPH.2003.019471.
    1. Coble YD, Davis RM, Head CA, Howe JP, Karlan MS, Kennedy WR, Numann PJ, Spillman MA, Skelton WD, Steinhilber MD, Strong JP, Wagner HN, Loeb JM, Rinaldi RC, Steindler EM, Atkinson RM, Beresford TP, Campbell J, Finlayson RE, Lisansky Gomberg ES, Kadri A, Spencer DL. Alcoholism in the elderly. JAMA. 1996 Mar 13;275(10):797–801. doi: 10.1001/jama.1996.03530340061031.
    1. Dufour M, Fuller RK. Alcohol in the elderly. Annu Rev Med. 1995;46:123–132. doi: 10.1146/annurev.med.46.1.123.
    1. Moore AA, Whiteman EJ, Ward KT. Risks of combined alcohol/medication use in older adults. Am J Geriatr Pharmacother. 2007 Mar;5(1):64–74.
    1. Klatsky AL. Alcohol and cardiovascular disease--more than one paradox to consider. Alcohol and hypertension: does it matter? Yes. J Cardiovasc Risk. 2003 Feb;10(1):21–24. doi: 10.1097/01.hjr.0000051960.68260.79.
    1. Klatsky AL, Friedman GD, Armstrong MA. The relationships between alcoholic beverage use and other traits to blood pressure: a new Kaiser Permanente study. Circulation. 1986 Apr;73(4):628–636.
    1. Fuchs FD, Chambless LE, Whelton PK, Nieto FJ, Heiss G. Alcohol consumption and the incidence of hypertension: The Atherosclerosis Risk in Communities Study. Hypertension. 2001 May;37(5):1242–1450.
    1. Taylor B, Irving HM, Baliunas D, Roerecke M, Patra J, Mohapatra S, Rehm J. Alcohol and hypertension: gender differences in dose-response relationships determined through systematic review and meta-analysis. Addiction. 2009 Dec;104(12):1981–1990. doi: 10.1111/j.1360-0443.2009.02694.x.
    1. Devanand DP. Comorbid psychiatric disorders in late life depression. Biol Psychiatry. 2002 Aug 1;52(3):236–242.
    1. Forlani M, Morri M, Belvederi MM, Bernabei V, Moretti F, Attili T, Biondini A, De RD, Atti AR. Anxiety symptoms in 74+ community-dwelling elderly: associations with physical morbidity, depression and alcohol consumption. PLoS One. 2014;9(2):e89859. doi: 10.1371/journal.pone.0089859.
    1. Chen WY, Colditz GA, Rosner B, Hankinson SE, Hunter DJ, Manson JE, Stampfer MJ, Willett WC, Speizer FE. Use of postmenopausal hormones, alcohol, and risk for invasive breast cancer. Ann Intern Med. 2002 Nov 19;137(10):798–804.
    1. Smith-Warner SA, Spiegelman D, Yaun SS, van den Brandt PA, Folsom AR, Goldbohm RA, Graham S, Holmberg L, Howe GR, Marshall JR, Miller AB, Potter JD, Speizer FE, Willett WC, Wolk A, Hunter DJ. Alcohol and breast cancer in women: a pooled analysis of cohort studies. JAMA. 1998 Feb 18;279(7):535–540.
    1. Neilsen NR, Gronbaek M. Interactions between intakes of alcohol and postmenopausal hormones on risk of breast cancer. International Journal of Cancer. 2008;122(5):1109–1113. doi: 10.1002/ijc.23195.
    1. Bikle DD, Stesin A, Halloran B, Steinbach L, Recker R. Alcohol-induced bone disease: relationship to age and parathyroid hormone levels. Alcohol Clin Exp Res. 1993 Jun;17(3):690–695.
    1. Schnitzler CM, Menashe L, Sutton CG, Sweet MB. Serum biochemical and haematological markers of alcohol abuse in patients with femoral neck and intertrochanteric fractures. Alcohol Alcohol. 1988;23(2):127–132.
    1. Chrischilles EA, Foley DJ, Wallace RB, Lemke JH, Semla TP, Hanlon JT, Glynn RJ, Ostfeld AM, Guralnik JM. Use of medications by persons 65 and over: data from the established populations for epidemiologic studies of the elderly. J Gerontol. 1992 Sep;47(5):M137–M144.
    1. Adams WL. Interactions between alcohol and other drugs. Int J Addict. 1995;30(13-14):1903–1923.
    1. Adams WL. Potential for adverse drug-alcohol interactions among retirement community residents. J Am Geriatr Soc. 1995 Sep;43(9):1021–1025.
    1. Lieber CS. Medical disorders of alcoholism. N Engl J Med. 1995 Oct 19;333(16):1058–1065. doi: 10.1056/NEJM199510193331607.
    1. Patterson TL, Jeste DV. The potential impact of the baby-boom generation on substance abuse among elderly persons. Psychiatr Serv. 1999 Sep;50(9):1184–1188. doi: 10.1176/ps.50.9.1184.
    1. Substance Abuse and Mental Health Services Administration . 2011. [2015-03-20]. The TEDS Report: Older Adult Admissions Reporting Alcohol as a Substance of Abuse: 1992 and 2009 .
    1. Hankin A, Daugherty M, Bethea A, Haley L. The emergency department as a prevention site: a demographic analysis of substance use among ED patients. Drug Alcohol Depend. 2013 Jun 1;130(1-3):230–233. doi: 10.1016/j.drugalcdep.2012.10.027.
    1. Centers for Disease Control. 2012. [2015-11-30]. Binge Drinking .
    1. National Institute on Alcohol Abuse and Alcoholism NIH: National Institute on Alcohol Abuse and Alcoholism. 2007. Helping Patients Who Drink Too Much: A Clinician's Guide Update 2005 .
    1. United States Census Bureau . [2015-03-20]. Newsroom Archive
    1. Stampfer MJ, Colditz GA, Willett WC, Speizer FE, Hennekens CH. A prospective study of moderate alcohol consumption and the risk of coronary disease and stroke in women. N Engl J Med. 1988 Aug 4;319(5):267–273. doi: 10.1056/NEJM198808043190503.
    1. Klatsky AL, Armstrong MA, Friedman GD. Alcohol and mortality. Ann Intern Med. 1992 Oct 15;117(8):646–654.
    1. Thun MJ, Peto R, Lopez AD, Monaco JH, Henley SJ, Heath CW, Doll R. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med. 1997 Dec 11;337(24):1705–1714. doi: 10.1056/NEJM199712113372401.
    1. Valmadrid CT, Klein R, Moss SE, Klein BE. The risk of cardiovascular disease mortality associated with microalbuminuria and gross proteinuria in persons with older-onset diabetes mellitus. Arch Intern Med. 2000 Apr 24;160(8):1093–1100.
    1. Mukamal KJ, Conigrave KM, Mittleman MA, Camargo CA, Stampfer MJ, Willett WC, Rimm EB. Roles of drinking pattern and type of alcohol consumed in coronary heart disease in men. N Engl J Med. 2003 Jan 9;348(2):109–118. doi: 10.1056/NEJMoa022095.
    1. Mukamal KJ, Maclure M, Muller JE, Sherwood JB, Mittleman MA. Prior alcohol consumption and mortality following acute myocardial infarction. JAMA. 2001 Apr 18;285(15):1965–1970.
    1. Sacco RL, Elkind M, Boden-Albala B, Lin IF, Kargman DE, Hauser WA, Shea S, Paik MC. The protective effect of moderate alcohol consumption on ischemic stroke. JAMA. 1999 Jan 6;281(1):53–60.
    1. Jayasekara H, MacInnis RJ, Hodge AM, Hopper JL, Giles GG, Room R, English DR. Alcohol consumption for different periods in life, intake pattern over time and all-cause mortality. J Public Health (Oxf) 2015 Dec;37(4):625–633. doi: 10.1093/pubmed/fdu082.
    1. Mukamal KJ, Kuller LH, Fitzpatrick AL, Longstreth WT, Mittleman MA, Siscovick DS. Prospective study of alcohol consumption and risk of dementia in older adults. JAMA. 2003 Mar 19;289(11):1405–1413.
    1. Beulens JWJ, Rimm EB, Ascherio A, Spiegelman D, Hendriks HFJ, Mukamal KJ. Alcohol consumption and risk for coronary heart disease among men with hypertension. Ann Intern Med. 2007 Jan 2;146(1):10–19.
    1. Jin Z, Xiang C, Cai Q, Wei X, He J. Alcohol consumption as a preventive factor for developing rheumatoid arthritis: a dose-response meta-analysis of prospective studies. Ann Rheum Dis. 2014 Nov;73(11):1962–1967. doi: 10.1136/annrheumdis-2013-203323.
    1. de VF, Dekker JM, Groeneveld WJA, Nijpels G, Stehouwer CDA, Bouter LM, Heine RJ. Moderate alcohol consumption is associated with lower risk for incident diabetes and mortality: the Hoorn Study. Diabetes Res Clin Pract. 2002 Jul;57(1):53–60.
    1. Howard AA, Arnsten JH, Gourevitch MN. Effect of alcohol consumption on diabetes mellitus: a systematic review. Ann Intern Med. 2004 Feb 3;140(3):211–219.
    1. Baker L, Wagner TH, Singer S, Bundorf MK. Use of the Internet and e-mail for health care information: results from a national survey. JAMA. 2003 May 14;289(18):2400–2406. doi: 10.1001/jama.289.18.2400.
    1. Silberg WM, Lundberg GD, Musacchio RA. Assessing, controlling, and assuring the quality of medical information on the Internet: caveant lector et viewor--Let the reader and viewer beware. JAMA. 1997 Apr 16;277(15):1244–1245.
    1. Kassirer JP. The next transformation in the delivery of health care. N Engl J Med. 1995 Jan 5;332(1):52–54. doi: 10.1056/NEJM199501053320110.
    1. Purcell GP, Wilson P, Delamothe T. The quality of health information on the internet. BMJ. 2002 Mar 9;324(7337):557–558.
    1. American Association of Retured Persons. 2009. [2015-03-20]. Bulletin Poll: Internet Use .
    1. Smith A. Pew Research Center - Internet, Science & Tech. 2014. Apr 3, [2015-12-01]. Older Adults and Technology Use .
    1. Bansil P, Keenan NL, Zlot AI, Gilliland JC. Health-related information on the Web: results from the HealthStyles Survey, 2002-2003. Prev Chronic Dis. 2006 Apr;3(2):A36.
    1. Cline RJ, Haynes KM. Consumer health information seeking on the Internet: the state of the art. Health Educ Res. 2001 Dec;16(6):671–692.
    1. Rice R. Influences, usage, and outcomes of Internet health information searching: multivariate results from the Pew surveys. Int J Med Inform. 2006 Jan;75(1):8–28. doi: 10.1016/j.ijmedinf.2005.07.032.
    1. Anderson J, Rainey M, Eysenbach G. The impact of CyberHealthcare on the physician-patient relationship. J Med Syst. 2003 Feb;27(1):67–84.
    1. Lieberman DZ, Huang SW. A technological approach to reaching a hidden population of problem drinkers. Psychiatr Serv. 2008 Mar;59(3):297–303. doi: 10.1176/appi.ps.59.3.297.
    1. . 2015. [2015-08-21].
    1. Office of Disease Prevention and Health Promotion U.S. Department of Health and Human Services. [2015-03-20]. Health Literacy Online: A Guide to Writing and Designing Easy-to-Use Health Web Sites .
    1. Glanz K, Rimer BK, Lewis FM. Health Behavior and Health Education: Theory, Research, and Practice. San Francisco: Jossey-Bass; 2002.
    1. Becker MH. The health belief model and personal health behavior. Health Educ Monogr. 1974;2:324–473.
    1. Harrison JA, Mullen PD, Green LW. A meta-analysis of studies of the Health Belief Model with adults. Health Educ Res. 1992 Mar;7(1):107–116.
    1. Janz N, Champion V, Strecher V. The health belief model. In: Glanz K, Rimer BK, Lewis FM, editors. Health Behavior and Health Education, 3rd edition. San Francisco: Jossey-Bass; 2002.
    1. Rosenstock IM. Why people use health services. Milbank Mem Fund Q. 1966 Jul;44(3):Suppl:94–127.
    1. Yang C, Maher J, Conroy D. Implementation of behavior change techniques in mobile applications for physical activity. Am J Prev Med. 2015 Apr;48(4):452–455. doi: 10.1016/j.amepre.2014.10.010.
    1. Cane J, Richardson M, Johnston M, Ladha R, Michie S. From lists of behaviour change techniques (BCTs) to structured hierarchies: comparison of two methods of developing a hierarchy of BCTs. Br J Health Psychol. 2015 Feb;20(1):130–150. doi: 10.1111/bjhp.12102.
    1. Knowles M. Andragogy in Action. San Francisco: Jossey-Bass; 1984.
    1. Knowles MS, Holton E, Swanson RA. The adult learner: the definitive classic in adult education and human resource development. Amsterdam: Elsevier; 2005.
    1. Dick W, Carey L. The Systematic Design of Instruction. 4th edition. New York: Harper and Collins; 1996.
    1. Leshin C, Pollock J, Reigeluth C. Instructional Design Strategies and Tactics. Englewood Cliffs, N.J: Educational Technology Publications; 1992.
    1. Wilson S, Fink A, Verghese S, Beck J, Nguyen K, Lavori P. Adding an alcohol-related risk score to an existing categorical risk classification for older adults: sensitivity to group differences. J Am Geriatr Soc. 2007 Mar;55(3):445–450. doi: 10.1111/j.1532-5415.2007.01072.x.
    1. Fink A, Elliott MN, Tsai M, Beck JC. An evaluation of an intervention to assist primary care physicians in screening and educating older patients who use alcohol. J Am Geriatr Soc. 2005 Nov;53(11):1937–1943. doi: 10.1111/j.1532-5415.2005.00476.x.
    1. Moore AA, Beck JC, Babor TF, Hays RD, Reuben DB. Beyond alcoholism: identifying older, at-risk drinkers in primary care. J Stud Alcohol. 2002 May;63(3):316–324.
    1. Fink A, Tsai MC, Hays RD, Moore AA, Morton SC, Spritzer K, Beck JC. Comparing the alcohol-related problems survey (ARPS) to traditional alcohol screening measures in elderly outpatients. Arch Gerontol Geriatr. 2002 Feb;34(1):55–78.
    1. Fink A, Morton SC, Beck JC, Hays RD, Spritzer K, Oishi S, Moore AA. The alcohol-related problems survey: identifying hazardous and harmful drinking in older primary care patients. J Am Geriatr Soc. 2002 Oct;50(10):1717–1722.
    1. Moore AA, Hays RD, Reuben DB, Beck JC. Using a criterion standard to validate the Alcohol-Related Problems Survey (ARPS): a screening measure to identify harmful and hazardous drinking in older persons. Aging (Milano) 2000 Jun;12(3):221–227.
    1. Fink A, Morton Sc, Beck Jc, Hays Rd, Spritzer K, Oishi S, Moore Aa. The alcohol related problems survey: comparisons to existing alcohol screening measures in an elderly ambulatory population. J Am Geriatr Soc. 1999;49(7):S11.
    1. Moore AA, Morton SC, Beck JC, Hays RD, Oishi SM, Partridge JM, Genovese BJ, Fink A. A new paradigm for alcohol use in older persons. Med Care. 1999 Feb;37(2):165–179.
    1. Nguyen K, Fink A, Beck JC, Higa J. Feasibility of using an alcohol-screening and health education system with older primary care patients. J Am Board Fam Pract. 2001;14(1):7–15.
    1. Fink A, Beck JC, Wittrock MC. Informing older adults about non-hazardous, hazardous, and harmful alcohol use. Patient Educ Couns. 2001 Nov;45(2):133–141.
    1. Nielsen Norman Group. 2000. [2015-11-30]. Why You Only Need to Test With 5 Users
    1. Ettner SL, Xu H, Duru OK, Ang A, Tseng C, Tallen L, Barnes A, Mirkin M, Ransohoff K, Moore AA. The effect of an educational intervention on alcohol consumption, at-risk drinking, and health care utilization in older adults: the Project SHARE study. J Stud Alcohol Drugs. 2014 May;75(3):447–457.
    1. Moore AA, Blow FC, Hoffing M, Welgreen S, Davis JW, Lin JC, Ramirez KD, Liao DH, Tang L, Gould R, Gill M, Chen O, Barry KL. Primary care-based intervention to reduce at-risk drinking in older adults: a randomized controlled trial. Addiction. 2011 Jan;106(1):111–120. doi: 10.1111/j.1360-0443.2010.03229.x.
    1. Moore AA, Morton SC, Beck JC, Hays RD, Oishi SM, Partridge JM, Genovese BJ, Fink A. A new paradigm for alcohol use in older persons. Med Care. 1999 Feb;37(2):165–179.
    1. Saunders J, Aasland O. World Health Organization Collaborative Project on the Identification and Treatment of Persons With Harmful Alcohol Consumption. Report on Phase I Development of a Screening Instrument. Geneva: World Health Organization; 1987. [2015-12-01]. Phase 1 report .
    1. Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption--II. Addiction. 1993 Jun;88(6):791–804.
    1. Bright S, Singh D, Fink A. International use of screening tools that measure 'standard drinks': whose standard? Addiction. 2011 May;106(5):1022–1023. doi: 10.1111/j.1360-0443.2011.03366.x.
    1. Bright SJ, Fink A, Beck JC, Gabriel J, Singh D. Development of an Australian version of the Alcohol-Related Problems Survey: a comprehensive computerised screening tool for older adults. Australas J Ageing. 2015 Mar;34(1):33–37. doi: 10.1111/ajag.12098.
    1. Fleming MF, Manwell LB, Barry KL, Adams W, Stauffacher EA. Brief physician advice for alcohol problems in older adults: a randomized community-based trial. J Fam Pract. 1999 May;48(5):378–384.
    1. Willard-Grace R, Chen EH, Hessler D, DeVore D, Prado C, Bodenheimer T, Thom DH. Health coaching by medical assistants to improve control of diabetes, hypertension, and hyperlipidemia in low-income patients: a randomized controlled trial. Ann Fam Med. 2015 Mar;13(2):130–138. doi: 10.1370/afm.1768.
    1. Dapp U, Anders JAM, von Renteln-Kruse W, Minder CE, Meier-Baumgartner HP, Swift CG, Gillmann G, Egger M, Beck JC, Stuck AE, PRO- AG. A randomized trial of effects of health risk appraisal combined with group sessions or home visits on preventive behaviors in older adults. J Gerontol A Biol Sci Med Sci. 2011 May;66(5):591–598. doi: 10.1093/gerona/glr021.
    1. Thompson BT, Schoenfeld D. Usual care as the control group in clinical trials of nonpharmacologic interventions. Proc Am Thorac Soc. 2007 Oct 1;4(7):577–582. doi: 10.1513/pats.200706-072JK.
    1. Fox S. Pew Internet and American Life Project. Washington, DC: Pew Research Center. Internet, Science & Tech; 2001. Jan 24, [2015-08-21]. Wired seniors
    1. Yarnall KSH, Pollak KI, Østbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention? Am J Public Health. 2003 Apr;93(4):635–641. doi: 10.2105/ajph.93.4.635.

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