Alcohol Use, Misuse, Abuse, and Dependence in Later Adulthood

Abstract

Considerable research has focused on alcohol problems in older adults, but the clinical utilization of this knowledge has lagged at least 3 decades behind the scientific developments. This unfortunate situation takes on added significance as the “baby boomer” generation ages because more of them drink more often in larger quantities than previous generations. This chapter focuses more on the ramifications of use, misuse, and abuse than on chronic dependence because the prevalence in the former categories far outweighs the latter.Older alcohol misusers and abusers are at excess risk for myriad physical problems and premature death because alcohol interacts with the natural aging process in negative ways to increase risks for injuries, hypertension, cardiac dysrhythmic events, cancers, gastrointestinal problems, neurocognitive deficits, bone loss, and emotional challenges, most notably depression. Low volume and less than daily alcohol consumption appear to be protective against blood clots in the coronary and brain vessels, bone loss and falls, and cognitive decline compared with current abstainers. At higher levels, alcohol has the opposite effect.Research findings strongly support positive outcomes of case finding, referral, and treatment of older adults who are misusing or abusing alcohol. However, there is ample evidence that health care providers across the spectrum of primary, acute, and long-term care ignore the signs and symptoms of alcohol misuse and abuse in their older patients and treat symptoms and sequelae of the abuse rather than confronting the abuse itself. Recommendations for changes in practice are made together with ideas for additional research in several areas where the current state of knowledge is inadequate, conflicting, or based on narrowly homogeneous samples.

Problem drinking and associated factors in older adults in South Africa

“…Firstly, the self-report of alcohol use should be interpreted with caution; it is possible that respondents underreported alcohol use, especially females. A number of risk factors associated with alcohol misuse or abuse in older adults reported in other studies (such as medication intake which may interact negatively with alcohol and religious involvement 3,4,8,13,14,17 ), were not assessed and should be assessed in future studies. For co-morbidities, given the limitations of self-reported morbidity, symptom questions and a related diagnostic algorithm were used to ascertain possible presence of co-morbidity conditions.…”

“…1 Alcohol abuse poses special risks for increased morbidity and mortality among older adults 2 including increased risks for accidents and injuries, hypertension, cardiac dysrhythmic events, cancers, gastrointestinal problems, liver disease, neurocognitive deficits, bone loss and depression. [3][4][5] Many older adults take medications that may interact negatively with alcohol. 6 Alcohol use data of older adults from high income countries indicates that: in Japan, 47.9% of men and 10.1% of women drank alcohol almost daily 7 ; in the USA, 9% of elderly Medicare beneficiaries reported unhealthy drinking, with higher prevalence in men (16%) than women (4%) 8 ; and also in the USA, Schultz et al 9 reported that about 15% of older persons in a rural state were at risk for alcoholism.…”

Drinking Patterns of Older Adults with Chronic Medical Conditions

“…55,56 At-risk drinkers may not have an alcohol disorder; however, heavy drinking episodes may be responsible for injuries and poor chronic disease outcomes. 22,58,59 The patient-centered medical home model of care being diffused nationally promises comprehensive, whole-person care that is facilitated and supported by electronic medical records. Alcohol screening with embedded counseling scripts in medical visit templates should be a component of such care, with the identification of and referral to appropriate resources as needed.…”

“…As adherence to treatment plans and self-management skills are essential to optimal chronic care management, alcohol consumption must be assessed and addressed. In light of the aging of the baby boomer generation, known to have higher alcohol consumption, 59 this call to action is timely and important.…”

Chapter 9; Substance Abuse

“…In the few studies that investigate gender differences in alcohol abuse, a consistent finding is that women have lower levels of consumption, are less likely to meet the criteria for alcohol abuse or dependence, and are more likely to abstain altogether (Chermack, Blow, Hill, & Mudd, 1996;Stevenson, 2005). A study of alcohol consumption, rather than incidence of abuse or dependence, among residents of San Diego County aged 65 and older, found that whites were more likely to use alcohol than African-American or Mexican-American respondents (Molgaard, Nakamura, Stanford, Peddecord, & Morton, 1990).…”