Two forms of alcoholism in elderly subjects can be distinguished: alcoholism beginning before the age of 65 years and continuing, and alcoholism beginning after the age of 65 years. Alcoholism in the elderly is often difficult to diagnose. In cases of alcohol consumption, elderly patients, who often take multiple medications, present an increased risk of medication/alcohol interactions, particularly with tranquillisers and sedatives.
Prevalence of alcoholism in the elderly
The majority of elderly individuals rarely drink alcohol, and half are completely abstinent for health reasons. Different studies of alcohol consumption in people aged 65 years and over in retirement homes or nursing homes give variable results: according to different authors, 8-70% of these individuals have a problem with alcohol abuse.
Elderly alcoholic subjects have either a history of excessive consumption since they were 40-50 years of age, or a moderate consumption which increases at times of strain. This late alcoholism in the elderly is often related to loneliness, loss of a spouse, a disabling illness and isolation. Some authors have observed a spontaneous reduction in alcohol consumption in elderly alcoholics. Lowering of the threshold of tolerance due to ageing seems to be the major factor in this relative self-control.
Difficulties in the diagnosis of alcoholism in the elderly
The general practitioner is undoubtedly the person who has most opportunity to identify alcoholism in an elderly patient, in whom social and family isolation are relatively common. However, the doctor is often confronted with denial of the problem by the patient and, especially, by the family.
In addition, the diagnostic tools usually used to identify alcoholism are not well suited to elderly populations and tend to under-estimate the problem:
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elderly patients have problems with memory and have difficulty evaluating their average consumption
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the principal assessment questionnaires, such as MAST, SMAST and CAGE, have been validated in adults with an average age well below 65 years
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use of quantitative criteria presents a problem of validity, since elderly subjects often have lower tolerance to alcohol, due to a reduction in their body fluid, cardiac output, metabolism and liver enzyme activity. It appears that elderly alcoholics consume less alcohol than the average for young drinkers
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many symptoms of alcohol abuse, such as muscular pain, insomnia, loss of libido, depression, anxiety, memory loss and cognitive changes, can be attributed to the age of the patient, while in a younger patient they can be linked to chronic alcohol consumption
Specific problems of alcoholism in the elderly
People of 65 years of age and above are more vulnerable to alcohol, and present health problems which are characteristic for their age. The main problems related to abusive alcohol consumption in the elderly are:
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changes in the immune system, with reduced resistance to infections and cancer.
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increased incidence of:
- cancer, especially of the oesophagus,
- hypertension, cardiac rhythm problems, myocardial infarction and cardiomyopathy,
- cerebro-vascular accidents,
- cirrhosis and other liver diseases.
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malnutrition.
The mortality rate from cirrhosis is 45% in elderly subjects, while for the general population it is only 22%. Cerebro-vascular accidents are common, but the difficulty is to determine whether they are the consequence of pathologies linked to ageing or to chronic alcoholism. In the elderly, alcohol also affects attention, balance and decreases sphincter control.
More than 70% of elderly patients take prescribed medications, of which half are tranquillisers and sedatives. Alcohol can interfere with these medications; such alcohol-medication interactions can be dangerous or even fatal (see Alcohol and medications). Patients have a greater risk of falls and confusion when small amounts of alcohol are taken along with psychotropic drugs. The physician must take particular care over the dosage of such medications in patients debilitated by alcohol consumption.
