Online education to inform the elderly about age-related alcohol risks: a randomized trial of effectiveness and costs

这项拟议的2期SBIR研究是一项随机试验，目的是评估“为晚年健康干杯吐司”的有效性。一个基于网络的病人教育计划，旨在防止老年人危险和有害的饮酒。该项目的具体目标是：1）提供可靠的信息，说明“为晚年健康干杯吐司！”减少饮酒老年患者中与酒精相关的风险和问题，2）评估这些减少与健康相关生活质量、患者知识和自我效能的提高以及健康服务使用和护理成本的降低的相关程度。该提案是为了响应NIAAA对“开发和评估旨在干预老年人与特定年龄相关的酒精问题风险的教育材料”的兴趣，以及NIH在卫生经济学研究中的最高优先领域，因为它旨在衡量特定干预措施对“医疗保健利用和健康结果”的实际或潜在影响。这项研究将对600名目前在洛杉矶一家大型社区医疗中心接受治疗的患者进行研究。县，服务于一个稳定和多样化的人口。老年人即使在相对较低的消费水平下也会经历酒精对健康的不利影响，因为与年龄相关的生理变化以及饮酒与慢性疾病、药物使用增加和功能状态下降的潜在不利相互作用。大约14.5%的老年人饮酒超过NIAAA的建议限制。在美国，过度饮酒每年平均造成88，000人死亡和250万年的潜在寿命损失，2006年50个州的平均成本为29亿美元。大部分的费用是由于酗酒。根据疾病预防控制中心的数据，老年人比年轻人更频繁地酗酒，饮酒过量会导致超过54种不同的伤害和疾病（包括车祸和暴力）。此外，对于那些经常酗酒的人来说，生病和死于酒精问题的机会显着增加。当考虑到健康和饮酒模式时，大约一半的老年饮酒者可能有遭受酒精相关伤害的风险，即使他们在建议的范围内饮酒。考虑到未来十年每天将有大约1万人年满65岁，到2030年，老年人的比例将增加到美国人口的20%以上，即使饮酒率保持不变，患有酒精相关风险的老年人数量也会增加。尽管如此，许多医生没有与老年患者讨论饮酒问题，部分原因是他们没有时间和培训，部分原因是现有的教育集中在年轻饮酒者身上。更复杂的是，观察证据表明，在一些老年人中，适度消费可能对心血管功能和死亡率产生有益影响。“为健康吐司！”涵盖了饮酒的范围及其益处和风险。如果有效且具有成本效益，该产品有可能实现重要的临床和社会效益。

This proposed Phase 2 SBIR study is a randomized trial of the effectiveness of “A Toast to Health in Later Life!” a web-based patient educational program designed to prevent hazardous and harmful drinking in older adults. The project's specific objectives are to 1) provide reliable information on the extent to which “A Toast to Health in Later Life!” reduces alcohol-related risks and problems among older patients who drink and 2) evaluate the extent to which these reductions are associated with increases in health-related quality of life, patient knowledge and self-efficacy and decreases in the use of health services and the costs of care. The proposal is being submitted in response to NIAAA's interest in the “development and evaluation of educational materials designed to intervene with the elderly around specific age-related risks for alcohol problems” and to NIH's highest priority areas in health economics research because it aims to measure the actual or potential impact of a specific intervention “on healthcare utilization and health outcomes.” The study will take place with 600 patients who currently drink and receive their care at a large community-based medical center in in L.A. County that serves a stable and diverse population. Older people can experience alcohol's unfavorable health effects even at relatively low consumption levels because of age-related physiological changes and drinking's potentially adverse interactions with chronic illness, increased medication-use and diminishing functional status. About 14.5% of older adults drink in excess of the NIAAA's recommended limits. Excessive alcohol consumption is responsible for an average of 88,000 deaths and 2.5 million years of potential life lost each year in the U.S. and cost the 50 States a median of $2.9 billion in 2006. Most of the costs are due to binge drinking. According to the CDC, older adults binge-drink more frequently than their younger counterparts, and drinking too much contributes to over 54 different injuries and diseases (including car crashes and violence). Further, the chance of getting sick and dying from alcohol problems increases significantly for those who binge drink more often. When health and drinking patterns are accounted for, about half of all older drinkers may be at risk for experiencing alcohol-related harm even if they drink within recommended limits. Considering that about 10,000 people will turn 65 every day for the next decade, and that the proportion of older adults will increase to more than 20% of the U.S. population by 2030, the number of older people with alcohol-related risks will increase even if drinking prevalence remains constant. Despite this, many physicians fail to discuss drinking with older patients, partly because they do not have the time and training to do so and partly because the available education focuses on younger drinkers. To complicate matters, observational evidence suggests that in some older adults, moderate consumption may have beneficial effects on cardiovascular functioning and mortality. “A Toast to Health in Later Life!” covers the spectrum of drinking and its benefits and risks. If effective and cost-effective, the product has the potential to achieve important clinical and societal benefits.