Clinical Review

Alcohol use disorders in elderly people–redefining an age old problem in old age

BMJ 2003; 327 doi: http://dx.doi.org/10.1136/bmj.327.7416.664 (Published 18 September 2003) Cite this as: BMJ 2003;327:664
  1. Henry O'Connell, research fellow (henryoconnell@hotmail.com)1,
  2. Ai-Vyrn Chin, lecturer in geriatric medicine1,
  3. Conal Cunningham, consultant geriatrician1,
  4. Brian Lawlor, Conolly Norman professor of old age psychiatry1
  1. 1Mercer's Institute for Research on Ageing, St James's Hospital, Dublin 8, Ireland
  1. Correspondence to: H O'Connell

    Alcohol use disorders in elderly people are common and associated with considerable morbidity. The ageing of populations worldwide means that the absolute number of older people with alcohol use disorders is on the increase, and health services need to improve their provision of age appropriate screening and treatment methods and services

    Introduction

    Media attention and public health initiatives related to alcohol use disorders tend to focus on younger age groups.13 However, alcohol use disorders are common among elderly people and are associated with notable health problems.2 Furthermore, in elderly people they are often underdetected and misdiagnosed4 as screening instruments and diagnostic criteria are geared towards younger people.5

    The ageing of populations worldwide means that the absolute number of elderly people with alcohol use disorders is on the increase,6 and a real danger exists that a “silent epidemic” may be evolving.

    Methods

    We searched PubMed for research papers and review articles in the area of alcohol use disorders in elderly people.

    How common is the problem?

    The prevalence of alcohol use disorders in elderly people is generally accepted to be lower than in younger people, but rates may be underestimated because of underdetection and misdiagnosis, the reasons for which are many and varied.7 The cross sectional nature of prevalence studies also means that a cohort effect cannot be ruled out. For example, the drinking habits of Americans from the 1920s may differ substantially from those from the era after the second world war because of the effects of prohibition.8

    Most prevalence studies have been carried out in North America, and results may not be generalisable to other cultures.7 Rates of alcohol use disorders also vary depending on the restrictiveness of diagnostic criteria used, with higher rates for “excessive alcohol consumption” and “alcohol abuse” than “alcohol dependence syndrome.” For …

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