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Risk of relapse within the first months after alcohol use disorder (AUD) interventions is substantial among older adults. For this vulnerable group, little information exists on how this risk is associated with residual DSM‐5 AUD symptoms after treatment. To investigate among older adults who received short‐term treatment for DSM‐5 AUD (1) the prediction of drinking behaviors and quality of life 12 months after treatment initiation by 6‐month DSM‐5 AUD symptoms, AUD severity, and AUD remission, and (2) whether these DSM‐5 AUD indicators provide prognostic information beyond that gained from 6‐month alcohol use (AU) status. The international multicenter RCT “ELDERLY‐Study” enrolled adults aged 60+ with DSM‐5 AUD. We used data from the subsample of 323 German and Danish participants with complete DSM‐5 AUD criterion information 6 months after treatment initiation (61% male; mean age = 65.5 years). AU was assessed with Form 90, DSM‐5 AUD with the M.I.N.I., and quality of life with the WHOQOL‐BREF. Generalized linear models were applied to investigate the associations between 6‐month AUD indicators and 12‐month AU and quality of life. Independent of AU at 6 months, having 1 (vs. no) residual AUD symptom at 6 months predicted a 12‐month “slip,” defined as exceeding a blood alcohol concentration of 0.05% at least once during that time (OR: 3.7, 95% CI: 1.5 to 9.0), heavy episodic drinking, and hazardous use (p< 0.05). AUD remission was associated with a lower risk of a “slip” at 12 months (p< 0.05). Failed reduction/cessation was associated with poorer physical health (Coef.: −0.4, 95% CI −0.7 to −0.1). For older adults, residual AUD symptoms in the first months after short‐term treatment predict problematic AU outcomes during the first 12 months after treatment entry. Thus, residual symptoms should be addressed in this patient population during posttreatment screenings. In older adults treated for DSM‐5 alcohol use disorder (AUD), we found that having at least one residual AUD symptom at the 6 month follow‐up after treatment predicted a 12 month ‘slip’ (exceeding a blood alcohol concentration of 0.05% at least once), heavy episodic drinking, and hazardous use (adjusted for 6 month alcohol use). Few significant associations showed between specific residual symptoms at 6 months and alcohol use at 12 months and between residual symptoms and quality of life at 12 months.

Only a minority of individuals with problematic alcohol use ever seek alcohol treatment. Knowledge of general help‐seeking behavior in the healthcare system can identify possibilities for prevention and intervention. The current study describes healthcare use, burden of disease, and prior morbidities over a 15‐year period by current alcohol use behavior among Danish adults aged 60–70. The Danish National Health Survey 2013 and the baseline assessment of the Elderly Study (2014–2016) were linked to Danish national registers to collect annual information on healthcare use and morbidity for the 15 years prior to inclusion. Participants from the 3 largest Danish municipalities were divided into 4 groups with varying drinking patterns and no recent treatment [12‐month abstinent (n= 691), low‐risk drinkers (n= 1978), moderate‐risk drinkers (n= 602), and high‐risk drinkers (n= 467)], and a group of treatment‐seeking individuals with a 12‐month DSM‐5 alcohol use disorder (AUD; n=262). Negative binomial regression models were utilized to compare rates of healthcare use and logistic regressions were used to compare odds of diagnoses. Low‐, moderate‐, and high‐risk drinkers had similar rates of past healthcare utilization (low‐risk mean yearly number of contacts for primary care 7.50 (yearly range 6.25–8.45), outpatient care 0.80 (0.41–1.32) and inpatient care 0.13 (0.10–0.21)). Higher rates were observed for both the 12‐month abstinent group (adjusted RR = 1.16–1.26) and the group with AUD (ARR = 1.40–1.60) compared to the group with low‐risk alcohol consumption. Individuals with AUD had higher odds of previous liver disease (adjusted OR = 6.30), ulcer disease (AOR = 2.83), and peripheral vascular disease (AOR 2.71). Twelve‐month abstinence was associated with higher odds of diabetes (AOR = 1.97) and ulcer disease (AOR = 2.10). Looking back in time, we found that older adults had regular healthcare contacts, with those who received treatment for AUD having had the highest contact frequency and prevalence of alcohol‐related diseases. Thus, healthcare settings are suitable locations for efforts at AUD prevention and intervention.

Studies have found that reductions in World Health Organization (WHO) drinking risk levels may be a stable outcome of treatment for alcohol use disorder (AUD) and associated with functional improvements. The aim of this study was to investigate whether posttreatment reductions in WHO drinking risk levels are stable over time among older adults and associated with a decrease in consequences of drinking and AUD symptoms and improved quality of life. Participants. Individuals 60+ years old, suffering from DSM‐5 AUD (n= 693), and seeking outpatient treatment. Measurements. WHO drinking risk levels, prior to treatment and at all follow‐up points up to 1 year after treatment start, were assessed with Form 90. Outcomes at follow‐up included consequences of drinking (Drinker Inventory of Consequences), quality of life (WHOQOL‐BREF), and DSM‐5 AUD symptoms (Mini International Neuropsychiatric Interview). Logistic regression and linear mixed models were used to examine the probability of maintaining risk‐level reductions at follow‐up and the association between risk‐level reductions and outcomes, respectively. Reductions in risk levels were maintained over time (at least 1 level: OR 5.39, 95% CI 3.43, 8.47; at least 2 levels: OR 9.30, 95% CI 6.14, 14.07). Reductions were associated with reduced consequences of drinking and number of AUD symptoms, and minor, but statistically significant, improvements in quality of life. Maintaining reductions in WHO risk levels appears achievable for older adults seeking treatment for AUD. The small reduction of AUD symptoms and improvement of quality of life indicates that these reductions may not be adequate as the only treatment goal. Data on treatment course of 963 60+ year‐old individuals suffering from Alcohol Use Disorder (AUD) in three countries (Denmark, Germany, and the US) showed that reductions in WHO drinking risk levels were stable over a one‐year follow‐up period. Reductions were associated with reduced consequences of drinking and number of DSM‐5 AUD symptoms. Maintaining reductions in WHO risk levels appear to be achievable for older adults with AUD and may be a feasible and stable outcome for treatment.

Abstract.Background:The number of older adults with alcohol use disorder (AUD) is expected to rise. Adapted treatments for this group are lacking and information on AUD features in treatment seeking older adults is scarce. The international multicenter randomized-controlled clinical trial “ELDERLY-Study” with few exclusion criteria was conducted to investigate two outpatient AUD-treatments for adults aged 60+ with DSM-5 AUD. Aims:To add to 1) basic methodological information on the ELDERLY-Study by providing information on AUD features in ELDERLY-participants taking into account country and gender, and 2) knowledge on AUD features in older adults seeking outpatient treatment. Methods: baseline data from the German and Danish ELDERLY-sites (n=544) were used. AUD diagnoses were obtained with the Mini International Neuropsychiatric Interview, alcohol use information with Form 90. Results:Lost control, desired control, mental/physical problem, and craving were the most prevalent (> 70 %) AUD-symptoms. 54.9 % reported severe DSM-5 AUD (moderate: 28.2 %, mild: 16.9 %). Mean daily alcohol use was 6.3 drinks at 12 grams ethanol each. 93.9 % reported binging. More intense alcohol use was associated with greater AUD-severity and male gender. Country effects showed for alcohol use and AUD-severity. Conclusion:European ELDERLY-participants presented typical dependence symptoms, a wide range of severity, and intense alcohol use. This may underline the clinical significance of AUD in treatment-seeking seniors.