Balancing individual rights and risks: A systematic review of qualitative studies of perspectives on older adults' alcohol use in residential care settings

An increasing number of older adults require residential care. Concurrently, older adults’ alcohol use is increasing. This review explored the perspectives of all relevant stakeholders on older adults’ alcohol use within residential care settings, through a systematic review and thematic synthesis of qualitative studies. Eight databases were searched for qualitative studies focusing on older adults’ alcohol consumption (defined as aged ≥ 50) within residential care settings, sampling any involved stakeholders, published up until January 2024. Quality appraisal utilised the Critical Appraisal Skills Programme checklist and included 15 studies of mainly moderate quality across seven high-income countries, reporting data from a range of stakeholders and representing varied older adults’ alcohol histories. Three themes were identified: alcohol use by older adults is socially acceptable and purposeful in residential care settings; alcohol helps in the pursuit of an ‘ideal’ outcome; and decision-making around older adults’ alcohol use varies depending on the involvement, knowledge, skills and beliefs of the participating stakeholders, who also vary. Reports of problematic alcohol use were rare and older adults in residential care settings should be supported to exercise their own choice in determining their alcohol use. However, residential care settings face particular challenges in managing the alcohol intake of older adults with limited mental capacity and alcohol dependency; owing to a lack of guidance, front-line staff make subjective decisions. Future research should develop guidance that involves all relevant stakeholders, including family members. Limitations include lack of generalisability to low- and middle-income countries and limited availability of raw data.