EAHC Workshop on Best Practice Models for Addiction Prevention Projects funded under the Health Programme –

Luxenbourg 25-26/01/2010

VINTAGE project.Best practices for prevention of 

alcohol-related harm in the elderly in the EU

Emanuele Scafato, Istituto Superiore di Sanità, Rome, ITALY

Director Population Health Unit -CNESPS

Osservatorio Nazionale Alcol – CNESPS WHO CC for Health Promotion and Research on Alcohol

National Centre on Epidemiology, Surveillance and Health Promotion

PresidentItalian Society of Alcohology - SIA

Project name: Good health into older age

Acronym: VINTAGE

Starting date: 01.03.2009

Duration: 18 months

Main beneficiary: ISS - Istituto Superiore di Sanità, Rome, Italy

Associated partners:

UNIMAAS - Maastricht University, NetherlandsGENCAT - Government of Catalonia, Barcelona, SpainIAS - Institute of Alcohol Studies, Huntingdon, United KingdomIVZ - Institute of Public Health, Ljubljana, SloveniaTHL - National Institute for Health and Welfare, Helsinki, FinlandSZU - National Institute of Public Health, Praha, Czech Republic

BackgroundHarmful alcohol use is common amongst older people: as many as 27% of European people aged 55+ years binge drinked (5+ drinks, 50g alcohol on one occasion) at least once a week during the previous 12 months (Eurobarometer 2007).Alcohol use disorders are common in older people, and with an ageing European population will increase in absolute numbers (O’Connell et al 2003). Despite the extent of harmful alcohol use among older people and this demographic shift, there are surprisingly few recent systematic reviews that document the full extent of such harm, or that provide the evidence base for cost effective policies and programmes to reduce it.VINTAGE aims at reducing this knowledge gap, by providing evidence base of harmful alcohol use among older people and collecting concrete and practical examples of best practice across all European countries, at country, regional and municipal levels.

INVITES MEMBER STATES TO

INVITES THE COMMISSION AND MEMBER STATES TO- include in existing information systems scientific data on alcohol consumption and harm

caused by harmful use of alcohol in the age group of 60 and above;

- develop and implement early identification and brief intervention procedures in primary and elderly health care and in school health settings

"THE COUNCIL OF THE EUROPEAN UNION:NOTES: - that older adults (aged 60 and above) are more sensitive to the effects of harmful use of alcohol than other adults, and that alcohol-related deaths among older adults have increased markedly over the last ten years, and that in some cases the death rate has more than doubled;

Osservatorio Nazionale Alcol - ISS-CNESPS - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS

20,4 20,5

25,4

4,6 4,77,0

19,7

13,0

23,8

43,0

48,1

9,313,1

6,84,6

15,3

0

10

20

30

40

50

60

11-15 16-17 18-24 25-44 45-64 65-74 75+

C lassi di e tà Totale

Maschio Femmine

ITALY. Hazardous (daily) drinkers exceeding the National Guidelines limits for alcohol

consumption. 2008

Osservatorio Nazionale Alcol - ISS-CNESPS - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS

The definition of hazardous drinkers (ISS criteria)

According to the Italian guidelines for a healthy diet

hazardous drinkers

are subjects who fulfil one of the following criteria:

1 standard unit = 12 grams

ITALY. Alcohol consumption

INTAKE by daily drinkers ONLY, by age

Contribution (%) of the different beverages to harmful consumption

46,1

80,9

95,9

39,2

15,2

3,1

14,7

1,0

3,9

0 10 20 30 40 50 60 70 80 90 100

11 - 18

19 - 64

>64

Wine Beer SpiritsMALE

Consumption estimate among daily drinkers only : 7.200.000 glasses

Consumption estimate among daily drinkers only : 20.500.000 glasses

Consumption estimate among daily drinkers only : 306.000 glasses

>64 59 % of glasses in excess

93,9

3,4 1,80,9

WINE BEER SPIRIT MIX

11-18 61.1 % of glasses in excess

37,7

24,3

19,3

18,7

WINE BEER SPIRIT MIX

19-64 19.5 % of glasses in excess

60,4

33,2 3,9

2,5

WINE BEER SPIRIT MIX

Contribution (%) of the different beverages to harmful consumption

DAILY

INTAKE

> 64

19-64

11-18

ITALY. Alcohol consumption , FEMALES

INTAKE by daily drinkers ONLY , by age

Contribution (%) of the different beverages to harmful consumption

34,9

88,5

98,2

45,3

9,7

1,8

19,8

1,8

0 10 20 30 40 50 60 70 80 90 100

11-18

19-64

>64

FEMALES

Consumption estimate among daily drinkers only: 2.500.000

Consumption estimate among daily drinkers only: 5.200.000

Consumption estimate among daily drinkers only: 51.300

11-18 47.7 % of glasses in excess

23,5

41,622,1

12,8

WINE BEER SPIRIT MIX

19-64 15.6 % of glasses in excess

71,1

4,7 5,219,0

WINE BEER SPIRIT MIX

>64 40.6 % of glasses in excess

97,3

1,21,6

WINE BEER SPIRIT MIX

Contribution (%) of the different beverages to harmful consumption

DAILY

INTAKE

> 64

19-64

11-18

At present, there is no indication that light to moderate alcohol drinking would be harmful to cognition and dementia, and it is not possible to define a specific beneficial level of alcohol intake.

Road accident in the elderly: the next priority?

Objectives and MethodsThe main objective of VINTAGE is to improve knowledge and to build capacity, at European, national and local level, in order to prevent the harmful use of alcohol among elderly subjects:provide evidence-based information on the impact of alcohol on health and well-being systematic reviews

collect examples of best practices, effective policies and programmes for the reduction of harmful alcohol use structured questionnaire

active dissemination of reports and database of best practices, relevant laws and infrastructures VINTAGE website + other online networks + list serve of stakeholders

VINTAGE websitehttp://www.epicentro.iss.it/vintage/

Evaluation Plan

An external evaluation has been undertaken, following a case study evaluation methodology: Process evaluation

analysis of written documentation (meeting notes and minutes, reports, etc.)

network survey to project staff and members, assessment of quality of information

Output evaluation review of project outputs, in terms of scientific accuracy,

readability, usability and ease of access, by a panel of selected scientists

Outcome evaluation assessment of long-term increased health and well-beeing

of elderly subjects through 3 intermediate measures (extent of dissemination, hits to websites and numbers of documents downloaded, stakeholders intention of modifying existing policies and practices)

Indicators used and link with the specific objectivesObjective Indicator Target

1. Report on alcohol and older people

1.1 Peer review and expert comments Peer review to the standard of an international scientific journal in the addictions field

1.2 Number of electronic copies disseminated

30 at EU level 250 at country level 75 at regional level200 at municipal level

1.3 Number of VINTAGE website hits to download document

300 hits per month, for the 6 months following document uploading

2. Collection of best practices

2.1 Number of practices identified 40 practices for at least 19 countries

2.2 Number of VINTAGE website hits to download best practices

300 hits per month, for the 6 months following document uploading

2.3 Number of HP-source website hits to access or download documentation on laws and infrastructures

200 hits per month, for the 6 months following uploading of VINTAGE information

3. Dissemination of findings

3.1 Number of electronic copies of reports, and information on web addresses of examples of best practices, relevant laws and infrastructures disseminated at different levels

30 at EU level 250 at country level 75 at regional level200 at municipal level

Definition adopted in the collection of PPbPCollected examples include a wide range of activities,

for example laws and policies to reduce BAC level in older people, restrictions to alcohol access, information messages and campaigns, or alcohol prevention and treatment services, sensitive to the elder's need, including the transition from work to retirement Project any action (research, prevention, etc.) endorsed with a clear start and end point

Programmea group of integrative, continuously implemented actions

bPracticesintervention approaches that, through experience or research, have been proven to reliably lead to a desired result (in a specific target group of people)

Time table of work packages and deliverables

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

WP1 - Project coordinationIstituto Superiore di Sanità

MC D1D4 MC

MC D7

WP2 - Results disseminationIstituto Superiore di Sanità

W D2 D3

WP3 - Project evaluationIstituto Superiore di Sanità

D8

WP4 - Evidence basedMaastricht University

D5

WP5 - Experience basedGeneralitat de Cataluña

D6D

MonthWPlead partner

D1 ProtocolD2 Dissemination planD3 Website disseminationD4 Interim technical and financial reportD5 Report on alcohol and older peopleD6 Report on best practicesD7 Final technical and financial reportD8 Evaluation report

MC Management committee meetingW Launch of websiteD Launch of database

Duration of the project 18 months: 01.03.09-31.08.10

Results achieved in reference to the specific objectivesEvidence base

Definition of aims, methods and procedures for the literature review on alcohol and older people

Start of the formal and grey literature searches (almost 200 relevant publications already identified). In progress

Experience base Definition of aims, methods and instrument for collecting

examples of PPbP Start of data collection (almost all countries already

contacted). In progress

Dissemination Design, implementation and launch of the project website

http://www.epicentro.iss.it/vintage/ Elaboration of the dissemination strategy Creation of a list serve of stakeholders for dissemination of

electronic copies of results. In progress

http://www.eurocare.org/library/latest_news/call_for_best_practices_on_preventing_the_harmful_use_of_alcohol_i

n_older_people__1

http://www.epicentro.iss.it/vintage/assessment.asp

VINTAGE criteria for evaluation of PPbPAccording to the original VINTAGE plan, collected examples of projects, programmes, practices, laws and infrastructures will be evaluated according to the following set of criteria:

Needs assessment Accessibility Setting approach Collaborative capacity building and partnership Evaluation Sustainability Transferability Availability of results Transparency of funding and support

Aims and methods for evaluating collected examples Ranking and rating collected examples is not a

goal of VINTAGE project and the results of the evaluation will not be public but internal

All findings (reports on literature review and examples of best practices, relevant laws and infrastructures), independently from their efficacy and effectiveness, will be disseminated to those responsible for aging population policy or alcohol policy and programme development, in order to encourage evidence- and experience-based decisions for the improvement of older people health and welfare

Any further analysis and evaluation of findings, even on the basis of EDDRA criteria, could be the possible objective of a VINTAGE2 project

THANK YOU FOR YOUR ATTENTION

Emanuele Scafato ISTITUTO SUPERIORE DI SANITA'

NATIONAL HEALTH INSTITUTEVia Giano della Bella, 34

00161 Rome, Italy 

Tel : (+39) 06 4990 4028 o 4029 (segr.)Fax:  (+39) 06 4990 4193Mob. (+39) 346 6959152

E-mail: emanuele.scafato@iss.it