Alcoholism in the elderly. How to spot and treat a problem the patient wants to hide

The Phenomenon of Substance Abuse among the Elderly: Part I

Because substance abuse, already a major problem among elderly people, is expected to worsen significantly during the 1990s, healthcare providers must be better prepared to identify and deal effectively with this important area of geriatric care. We present an overview of the phenomenon of substance abuse among the elderly with particular attention to the abuse of alcohol and benzodiazepines, the two substances most commonly abused by elderly people. Traditionally, substance abuse among the elderly has gone largely unrecognized because of a low level of suspicion, misdiagnosis, and concealment. It is axiomatic that problems cannot be solved unless they are first identified and appropriately characterized. To respond to the increasing problem of substance abuse among the elderly, healthcare providers must recognize that elderly people are at particular risk for substance abuse, and because of their heterogeneity, they require individualized and diverse prevention and treatment approaches. Once the abuse is identified and properly characterized, specific prevention and treatment strategies can be developed and implemented.

The prevalence of harmful and hazardous alcohol consumption in older U.S. adults: data from the 2005-2008 National Health and Nutrition Examination Survey (NHANES)

BACKGROUND

Alcohol consumption and its interaction with disease, medication use, and functional status may result in serious health problems, but little information exists about the national prevalence of alcohol-related health risk in older adults.

OBJECTIVE

To estimate the prevalence of harmful and hazardous alcohol use and the prevalence of consumption in excess of National Institute of Alcohol Abuse and Alcoholism (NIAAA) recommendations, in people aged 65 and older, and by sex and race/ethnicity sub-group.

DESIGN

Cross-sectional, using data from the 2005-2008 National Health and Nutrition Examination Survey of the non-institutionalized U.S. population.

PARTICIPANTS

One thousand and eighty-three respondents aged 65 and older who consume alcohol.

MAIN MEASURES

Participants' alcohol consumption was classified as Harmful, Hazardous, or Healthwise, in the context of their specific health status, using the Alcohol-Related Problems Survey classification algorithm.

KEY RESULTS

Overall, 14.5 % of older drinkers (95 % CI: 12.1 %, 16.8 %) consumed alcohol above the NIAAA's recommended limits. However, when health status was taken into account, 37.4 % of older drinkers (95 % CI: 34.9 %, 40.0 %) had Harmful consumption and 53.3 % (95 % CI: 50.1 %, 56.6 %) had either Hazardous or Harmful consumption. Among light/moderate drinkers, the proportions were 17.7 % (95 % CI: 14.7 %, 20.7 %) and 28.0 % (95 % CI: 24.8 %, 31.1 %), respectively. Male drinkers had significantly greater odds of Hazardous/Harmful consumption than female drinkers (OR = 2.14 [95 % CI: 1.77, 2.6]). Black drinkers had worse health status and significantly greater odds of Hazardous/Harmful consumption than white drinkers (OR = 1.49; 95 % CI: 1.02, 2.17), despite having no greater prevalence of drinking in excess of NIAAA-recommended limits.

CONCLUSION

Most older Americans who drink are light/moderate drinkers, yet substantial proportions of such drinkers drink in a manner that is either harmful or hazardous to their health. Older adults with risky alcohol consumption are unlikely to be identified by health care providers if clinicians rely solely on whether patient consumption exceeds the NIAAA-recommended limits.

Role and attitude of companions on geriatric psychiatry outpatient visits in Taiwan

The purpose of the present paper was to investigate the role and attitude of people who accompanied geriatric patients to an outpatient psychiatric clinic. The study was conducted at a large university hospital in Taiwan. Participants included 108 patients aged 65 years and older who were seen for their initial psychiatric visit; 81 patients were accompanied. All accompanying people were interviewed to obtain their assumed role and attitude during the visit. Data were gathered prospectively; statistical analyses were performed using SPSS-PC. Accompanied patients (75% of participants) were older than those in the unaccompanied group. Most patients (53.1%) were accompanied by adult children who lived with them. Of the accompanying spouses, 48% were described as a supporter, and 60% showed a positive attitude. Most of the accompanying children acted as critics and speakers. Accompanying people whose responsible patients reported insomnia and suicide attempts showed a significantly positive attitude, whereas people who accompanied alcoholic patients were more negative and assumed a critic role. Many accompanying people requested further examination and drug treatment and expressed concern that the patient may be mentally ill. The role and attitude of accompanying people on the geriatric patient encounter are important factors in promoting patient-doctor communication and trust.

The nurse's role in assessing alcohol use by older people

Nurses have the potential to carry out health promotion activity related to alcohol use in a range of settings where older people receive care. The majority of the literature on alcohol use in later life has focused on abuse, especially on the more common risk of drug-alcohol interactions. In order to work effectively with older people in health prevention and education, nurses need to be knowledgeable about older people's patterns of drinking, the effects of alcohol on medication and the current evidence on the harm and benefits of alcohol to health. In carrying out assessments, a skillful approach needs to be adopted in questioning older clients on what some might regard as a sensitive issue. Screening tools for the detection of alcohol abuse in the general adult population may not be valid for use with older clients. Tools specific to the detection of alcohol abuse by older people will be considered.

Substance use disorders in a geriatric psychiatry outpatient clinic: prevalence and epidemiologic characteristics

This study was conducted to determine the prevalence of substance use disorders in a geriatric psychiatry outpatient clinic. The overall prevalence for any substance use disorder was 20% (N = 28). The prevalence of benzodiazepine dependence was 11.4% (N = 16); the prevalence of alcohol dependence was 8.6% (N = 12); and the prevalence of prescription narcotic dependence was 1.4% (N = 2). These findings suggest that substance use disorders in the geriatric psychiatry outpatient population exist to a significantly greater extent than previously reported. Descriptive statistics were used to characterize patients with benzodiazepine dependence, alcohol dependence, and no substance use disorder. These groups were compared on demographic and clinical variables using one-way analysis of variance (ANOVA) and chi-squared statistical techniques. Clinicians working in comparable outpatient settings may be in a better position to prevent, detect, and treat substance use disorders in their patients as a result of increased awareness of its epidemiologic characteristics in this population.

A descriptive study of elderly community-dwelling alcoholic patients in the rural south

Alcohol-related disorders, estimated to be more prevalent in the South, are associated with serious comorbid disorders, such as depression and suicide. In a rural outreach program, the authors examined patients with a diagnosis of alcoholism and compared them with nonalcoholic patients on various demographic and descriptive variables. Of 166 patients referred to the program, 35 (21.1%) had an alcohol-related disorder. Alcoholism was significantly associated with male gender and younger age, but nearly half of the alcoholic subjects were women. Alcoholism is associated with inappropriate health care utilization; alcohol-related disorders produced significantly more emergency room visits and somewhat more hospital admission; these patients were less likely to have a primary care physician. No patient was receiving treatment for alcoholism.

Alcohol in the elderly

Although older individuals drink less and report fewer alcohol-related problems than do younger individuals, alcohol use and abuse are significant health issues for older patients. The signs and symptoms of alcohol problems and dependence in the elderly may not only differ from those of young problem drinkers, but may also be present at lower levels of alcohol consumption. Older alcoholics do well in alcohol treatment. Therefore, discussion of alcohol consumption is a critical part of every history and physical examination for all patients, including older individuals.

Alcohol use and abuse in the frail, homebound elderly: a clinical analysis of 103 persons

We studied alcohol use and abuse in 103 frail, homebound elderly individuals cared for in a long-term home health care program from July 1991 to February 1992. Their average age was 80.63 years. Eighty-four percent were abstinent at the time of the study, including 25 (25%) past heavy drinkers. Two persons were current heavy drinkers and 14 continued to drink socially. Previous alcohol use or abuse was associated with a history of smoking, cardiovascular morbidity, social isolation, and anxiety or agitation. Current social drinking was associated with sedative-hypnotic use as well as smoking. Twenty-three of 25 past heavy drinkers remained sober on our programs without the use of formal alcohol treatment. Abstinence is known to increase with age, appears to be fostered by the homebound setting, is feasible for homebound elderly persons and is often accepted.

Gender differences in the individual characteristics and life contexts of late-middle-aged and older problem drinkers

This study focuses on gender differences in the individual characteristics and life contexts of late-life problem drinkers. Late-middle-aged women with drinking problems (n = 183) consumed less alcohol, had fewer drinking problems, and reported more recent onset of drinking problems than did their male counterparts (n = 476). They also used more psychoactive medications, were more depressed, and were less likely to seek alcohol treatment. Consistent with a gender role perspective on alcohol abuse, problem-drinking women had more family-related and fewer financial stressors than did problem-drinking men. Contrary to expectation, however, problem-drinking women reported more support from children, extended family members, and friends than did problem-drinking men. Moreover, women who continued to have drinking problems over a 1-year interval reported some unexpected short-term benefits at follow-up, including reduced spouse stressors. Women who had remitted at follow-up experienced less spouse support, and more family-related stressors and depression than did remitted men. They also lost support from extended family members over the 1-year interval. The results suggest a need for screening and treatment efforts tailored more closely to the life circumstances of women with late-life drinking problems.

Comparisons of Purpose in Life scores between alcoholics with early and later onset

No significant differences were found on Purpose in Life scores of 33 early onset (before age 40) and 27 late onset (after 40 years of age) alcoholic men in alcoholism treatment centers. Differences were found between the later onset group and another group of early onset alcoholics (n = 38) as well as an older nonalcoholic group of 20 tested by Meier and Edwards.