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This study aimed to establish expert consensus on effective and applicable elements, including their underlying mechanisms to reduce problematic alcohol use; and explore which elements are most effective and which mechanisms are important for older adults with lower\u2010 and higher\u2010severity problematic alcohol use, resulting in a programe theory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A three\u2010round questionnaire\u2010based Delphi study was conducted in the Netherlands. In the first (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200920) and second round (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200918), experts with treatment, research, policy, intervention development, educational and lived experience, rated 85 elements on their effectiveness and applicability, and mechanisms on exploratory power. In the third round (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200918), 40 elements and 39 mechanisms with consensus were ranked on effectiveness and importance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The most effective and applicable elements with consensus were\n                      <jats:italic>addressing age\u2010related issues<\/jats:italic>\n                      and the\n                      <jats:italic>combination of drinking and smoking<\/jats:italic>\n                      ;\n                      <jats:italic>using motivational interviewing techniques<\/jats:italic>\n                      ; having an\n                      <jats:italic>empathic, supportive and listening practitioner<\/jats:italic>\n                      ; and\n                      <jats:italic>having therapeutic alliance.<\/jats:italic>\n                      Mechanisms best explaining the elements' effectiveness were\n                      <jats:italic>enabling early identification and timely intervention,<\/jats:italic>\n                      and\n                      <jats:italic>feeling recognised and acknowledged in group interventions<\/jats:italic>\n                      . For older adults with lower\u2010severity problematic alcohol use, insight into their use was particularly important, whereas for those with higher\u2010severity, self\u2010efficacy was important.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and Conclusions<\/jats:title>\n                    <jats:p>Elements and mechanisms related to motivation, personalisation, lifestyle, life stage, and relational connections with practitioners and\/or group members were found particularly effective and important. The programe theory can inform the development of interventions for older adults with problematic alcohol use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dar.70237","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T02:04:48Z","timestamp":1788919488000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["What Works for Older Adults to Reduce Problematic Alcohol Use: A Delphi Study on Elements and Mechanisms in Interventions"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-2247-8446","authenticated-orcid":false,"given":"Fieke A. 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