TY - GEN
T1 - Understanding gender differences in treatment outcomes among older adults with alcohol use disorder
AU - Tryggedsson, Jeppe
PY - 2024/11/25
Y1 - 2024/11/25
N2 - Background
Alcohol Use Disorder (AUD) among older adults is an increasing public health
concern, especially in Western countries with aging populations. Older adults
face distinctive challenges in the development and treatment of AUD due to factors such as age-related physiological changes, increased alcohol sensitivity,
and the presence of comorbidities. Additionally, psychosocial stressors like widowhood, retirement, and social isolation contribute to the complexity of AUD in
this demographic. Research on gender differences in AUD treatment outcomes
has shown conflicting results, with some studies suggesting women may have
better treatment outcomes, while others find no significant differences. Additionally, quality of life (QoL) has emerged as an important outcome in assessing the
broader impact of AUD treatment beyond alcohol consumption.Objective
This thesis aims to investigate gender differences in drinking-related treatment
outcomes and QoL among older adults receiving treatment for AUD, while also
identifying and investigating QoL instruments used in AUD research.Methods
The thesis consists of three papers. Papers I and II investigated gender differences in drinking-related and QoL outcomes across a one-year follow-up period, using data from the Elderly Study, a large multinational, randomized controlled trial of 693 older adults (aged 60+) with DSM-5 AUD. All patients received four weeks of motivational enhancement therapy, and some received additional treatment using the community reinforcement approach. Patients were
assessed at baseline, after 4 weeks, 12 weeks, 26 weeks, and 52 weeks,
providing information on, among other things, alcohol consumption and QoL.In Paper I, both continuous and binary alcohol consumption measures were analysed to identify gender differences in treatment outcomes. Paper II focused on
QoL outcomes, assessing changes in physical, psychological, social, and environmental well-being and explored whether gender influenced these improvements. Mixed-effects linear and logistic regression models were used to evaluate gender differences from baseline up to the one-year follow-up.Paper III is a systematic review of QoL assessment instruments used in AUD
research, examining the psychometric properties of commonly used instruments. The review followed PRISMA guidelines and was registered in PROSPERO. A search was conducted on PubMed, EMBASE, and PsycINFO to include original clinical trials of adults AUD populations, utilizing a formal QoL assessment instrument. Study characteristics and information on QoL assessment
instruments were extracted to provide a comprehensive overview. Lastly, the
psychometric properties of instruments used in five or more studies were evaluated.Results
The findings from Papers I and II showed that while men generally reported
higher alcohol consumption at baseline, both men and women experienced significant reductions in drinking over time following treatment. On measures
where men reported higher baseline consumption, women showed smaller reductions compared to men, resulting in no significant gender differences after
treatment. In terms of QoL, both men and women experienced significant improvements across various domains from baseline up to one year after treatment, with no significant gender differences. The systematic review identified 19 different QoL assessment instruments used
across 61 clinical alcohol trials. Five instruments were used five times or more,
with the SF-36 being the most frequently used. While some instruments have
demonstrated good psychometric properties, results emphasized that further
validation is needed to ensure that instruments adequately capture QoL in AUD
populations.Conclusions
Older men and women show differences in alcohol consumption, but these diminish with treatment, and no consistent gender differences are observed in
drinking outcomes up to one year after treatment, indicating similar treatment
efficacy. Both genders also experience significant and comparable QoL improvements across multiple domains, reinforcing the broader benefits of treatment beyond alcohol reduction. Using robust assessment instruments is essential for accurately measuring QoL outcomes. In conclusion, this thesis underscores the importance of addressing both clinical and psychosocial factors in
AUD treatment for older adults, regardless of gender, and highlights the need to
further validate QoL instruments to better support recovery in AUD populations.
AB - Background
Alcohol Use Disorder (AUD) among older adults is an increasing public health
concern, especially in Western countries with aging populations. Older adults
face distinctive challenges in the development and treatment of AUD due to factors such as age-related physiological changes, increased alcohol sensitivity,
and the presence of comorbidities. Additionally, psychosocial stressors like widowhood, retirement, and social isolation contribute to the complexity of AUD in
this demographic. Research on gender differences in AUD treatment outcomes
has shown conflicting results, with some studies suggesting women may have
better treatment outcomes, while others find no significant differences. Additionally, quality of life (QoL) has emerged as an important outcome in assessing the
broader impact of AUD treatment beyond alcohol consumption.Objective
This thesis aims to investigate gender differences in drinking-related treatment
outcomes and QoL among older adults receiving treatment for AUD, while also
identifying and investigating QoL instruments used in AUD research.Methods
The thesis consists of three papers. Papers I and II investigated gender differences in drinking-related and QoL outcomes across a one-year follow-up period, using data from the Elderly Study, a large multinational, randomized controlled trial of 693 older adults (aged 60+) with DSM-5 AUD. All patients received four weeks of motivational enhancement therapy, and some received additional treatment using the community reinforcement approach. Patients were
assessed at baseline, after 4 weeks, 12 weeks, 26 weeks, and 52 weeks,
providing information on, among other things, alcohol consumption and QoL.In Paper I, both continuous and binary alcohol consumption measures were analysed to identify gender differences in treatment outcomes. Paper II focused on
QoL outcomes, assessing changes in physical, psychological, social, and environmental well-being and explored whether gender influenced these improvements. Mixed-effects linear and logistic regression models were used to evaluate gender differences from baseline up to the one-year follow-up.Paper III is a systematic review of QoL assessment instruments used in AUD
research, examining the psychometric properties of commonly used instruments. The review followed PRISMA guidelines and was registered in PROSPERO. A search was conducted on PubMed, EMBASE, and PsycINFO to include original clinical trials of adults AUD populations, utilizing a formal QoL assessment instrument. Study characteristics and information on QoL assessment
instruments were extracted to provide a comprehensive overview. Lastly, the
psychometric properties of instruments used in five or more studies were evaluated.Results
The findings from Papers I and II showed that while men generally reported
higher alcohol consumption at baseline, both men and women experienced significant reductions in drinking over time following treatment. On measures
where men reported higher baseline consumption, women showed smaller reductions compared to men, resulting in no significant gender differences after
treatment. In terms of QoL, both men and women experienced significant improvements across various domains from baseline up to one year after treatment, with no significant gender differences. The systematic review identified 19 different QoL assessment instruments used
across 61 clinical alcohol trials. Five instruments were used five times or more,
with the SF-36 being the most frequently used. While some instruments have
demonstrated good psychometric properties, results emphasized that further
validation is needed to ensure that instruments adequately capture QoL in AUD
populations.Conclusions
Older men and women show differences in alcohol consumption, but these diminish with treatment, and no consistent gender differences are observed in
drinking outcomes up to one year after treatment, indicating similar treatment
efficacy. Both genders also experience significant and comparable QoL improvements across multiple domains, reinforcing the broader benefits of treatment beyond alcohol reduction. Using robust assessment instruments is essential for accurately measuring QoL outcomes. In conclusion, this thesis underscores the importance of addressing both clinical and psychosocial factors in
AUD treatment for older adults, regardless of gender, and highlights the need to
further validate QoL instruments to better support recovery in AUD populations.
U2 - 10.21996/q5kc-3n41
DO - 10.21996/q5kc-3n41
M3 - Ph.D. thesis
PB - Syddansk Universitet. Det Sundhedsvidenskabelige Fakultet
ER -