At-risk older drinkers who completed all three health educator calls were more likely to transition to not at-risk status at 3 months compared to those who did not complete any calls. However, the effectiveness of the health educator calls was no longer apparent at 12 months. Prior to the health educator call, all subjects had received personalized risk reports, visits with their physicians, and educational booklets on alcohol and aging.
It is possible that motivation to change at baseline played a role in both completing health educator calls and eventual reduction in risky drinking at 3 months. If motivation was the key factor, we would have expected individuals who completed one or two calls to fare better than those who did not complete any calls. The findings instead indicated that individuals who completed only one or two calls did not have significant differences in any outcomes at 3 or 12 months compared to those who did not complete any calls. This pattern of results supported a decreased likelihood that motivation was a confounder and suggested that having at least three calls, rather than fewer, was necessary to reduce drinking among older at-risk drinkers.
The telephone has been utilized effectively for monitoring and treatment of various disorders, including depression,37–40
and alcohol misuse.31,32,38
Studies focusing on use of telephone-based intervention in alcohol misuse found reductions in the number of risky drinking days in men with alcohol dependence,31
in total alcohol consumption in at-risk adult drinkers in primary care practices,32
and in impaired driving among adult patients who screened positive for high-risk alcohol use in the emergency department.33
A study that focused on older drinkers in primary and specialty care at the Veterans Administration found that telephone management induced greater reduction in drinking compared to usual care.38
There are several advantages of using telephone-based intervention. These interventions can be performed by non-physician providers,31–33,38,40–42
potentially circumventing some of the current barriers that exist in implementing brief intervention in primary care, and increasing the number of health professionals available to reach more at-risk drinkers. Use of the telephone could potentially yield higher rates of self-reported alcohol-related harm compared to face-to-face interview, fostered by the increased anonymity associated with telephone conversations.43
In our study, the effect of a health educator call on risk outcomes was evident at 3 months, but the impact was less at 12 months. We found that the majority of subjects’ risk outcomes remained the same for both 3 and 12 months, suggesting that most of the changes had occurred early in the trial. Additionally, the lack of effect seen at 12 months could be due to the fact that all three calls were completed during the first eight weeks of the trial, and the effects on at-risk outcomes and drinking could potentially be sustained longer if the calls had been spread out more evenly or occurred more frequently throughout the trial. Other studies of telephone-based intervention included more frequent or intensive telephone counseling sessions,31,32,38,44
and one study found beneficial effects up to 24 months in younger adults.44
Future studies would be needed to address whether more frequent or intensive telephone sessions would have more impact on long term outcomes for older at-risk drinkers.
There were several limitations of this study. The health educator call was a component of a multi-faceted intervention for older at-risk drinkers in this trial. Therefore, it is possible that other parts of the intervention influenced the impact of the telephone calls. Since health educator calls were embedded in the overall intervention strategy, we were unable to conclude whether use of telephone calls alone would be effective in reducing risky alcohol use among older drinkers. Also, not every intervention subject completed a call, and systemic differences among the two groups, including motivation for change, could potentially bias the result. Although it is not surprising that individuals who did not complete health educator calls had lower rates of completing follow-up surveys, this differential response between those who completed at least a call and those who did not complete any call could potentially introduce bias. We attempted to control for the differential response in the final models by including variables associated with completion of surveys. Furthermore, our sample was composed mainly of non-Hispanic white men, and findings need to be replicated among more diverse group of older adults to improve generalizability of our findings.
In conclusion, we found that health educator telephone call was moderately efficacious in short-term reduction of risky alcohol use among older drinkers in primary care settings. However, the effect did not persist at 12 months, and further research would be needed to determine if telephone-based intervention can be effective in long term reduction of risky drinking among older adults. These findings provide the first data regarding the impact of telephone-based intervention among older adults identified as at-risk drinkers when considering not only the amount they drink but also comorbidities and use of medications that may increase alcohol-related harm. This study adds to the literature suggesting that telephone can be a useful strategy to deliver interventions for unhealthy alcohol use.