Evaluation and Management of Alcohol use Disorder among Older Adults

Abstract

Purpose of Review The prevalence of alcohol use disorder (AUD) among older adults in the United States is rising, but remains underdiagnosed, underreported, and inadequately managed. This review highlights the medical, social, and cultural factors of AUD in older adults and provides guidelines for its screening, evaluation, and management. Recent Findings The COVID-19 pandemic has created additional challenges and barriers to care, as older adults may have disproportionate worsening of anxiety, depression, and substance use resulting from increased isolation related to physical distancing and shelter-in-place guidelines. Summary All older adults should be routinely screened for AUD with standardized screening tools. If a patient's screening results are positive, a clinician should conduct a brief assessment, which may be supplemented by laboratory tests. Most older adults at risk for alcohol misuse do not need specialized SUD treatment, but most can benefit from Screening, Brief Intervention, and Referral to Treatment (SBIRT) to prevent substance misuse before it occurs. Medications for the treatment of AUD in older adults include naltrexone, acamprosate, disulfiram, gabapentin and topiramate. Psychosocial treatments, including mutual help groups, are equally important.

Global and regional burden of alcohol-associated liver disease and alcohol use disorder in the elderly

“…Furthermore, the characteristics of AUD identified by conventional screening tools such as CAGE, AUDIT, or mean corpuscular volume may not be entirely generalizable to older individuals. [18] , [19] , [20] , [21] , [22] Hence, there is a need for screening methods specifically tailored to the elderly population that can effectively identify AUD in this demographics. As previous studies have suggested, treatment for AUD can be advantageous for older individuals, similar to their younger counterparts.…”

Alcohol Misuse Screening Performance Improvement Initiative

“…The CAGE screening scores range from zero (negative responses to the four screening questions) to a maximum score of four (positive responses to all four screening questions). A positive response to any of the four questions may indicate alcohol misuse (Joshi et al, 2021). A CAGE score of two or more is considered clinically significant and a positive screening (Ewing, 1984).…”

Using Machine Learning Methods to Assess the Risk of Alcohol Misuse in Older Adults

“…In many cases, alcohol misuse in older adults is underdiagnosed with improper assessment and management 43,44 . In fact, of those who admitted to having ongoing alcohol misuse in the UKB cohort, only 12.5% of these patients had any alcohol-related F.10 ICD-10 code (Supplementary Figure 4).…”