Roland M. Atkinson

Alcohol related dementia: Proposed clinical criteria

Current diagnostic criteria for Alcohol Related Dementia (ARD) are based almost exclusively on clinical judgment. Moreover, there are no guidelines available to assist the clinician or the researcher in distinguishing Alcohol Related Dementia from other causes of dementia such as Alzheimers Disease (AD). However, this distinction may have implications for the prognosis and treatment of patients. In this article, provisional diagnostic criteria for establishing a diagnosis of Alcohol Related Dementia are proposed for further study. The criteria are based on the available literature on the relationship between alcohol consumption and dementia and were modeled after existing diagnostic criteria for AD and Vascular Dementia. Validity of these criteria for distinguishing AD from ARD will require further study.

Aging and alcohol use disorders: diagnostic issues in the elderly.

Alcohol use and use disorders in older people tend to be hidden and ignored by clinicians and scholars. Resulting misinformation about elderly alcohol problems can be found in such fundamental works as the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised. Yet, an extensive literature about the nature of geriatric alcohol problems has developed recently. This article reviews that literature, comments on current research at several North American centers, and offers some new information from the authors study of more than 300 older male alcoholics. Many findings remain to be replicated and further verified. Nonetheless, several coherent strands of information seem to be well substantiated: (a) problem drinking in the elderly constitutes a public health problem of moderate proportion, especially in men; (b) most signs predict increasing problem drinking in coming generations of elderly women and men; (c) many cases of geriatric alcoholism have late onset; (d) many geriatric cases are not properly identified; and (e) present screening and diagnostic methods for alcohol use disorders lack adequate validation for older persons.

Screening for Alcohol Use Disorders in the Nursing Home

OBJECTIVES: To determine the prevalence of Alcohol Use Disorders (AUDs) among residents of a Veterans Affairs (VA) nursing home (NH) using DSM‐III‐R criteria for alcohol abuse and dependence, and to examine the demographic variables associated with AUDs among NH residents. A third objective was to assess the sensitivity, compared with DSM‐III‐R criteria, of three screening tests for AUDs in the NH: the CAGE, the MAST‐G, and the two‐question instrument developed by Cyr and Wartman.

Alcohol and Substance-Use Disorders in the Elderly

Publisher Summary This chapter presents a general review of substance abuse in the elderly such as alcohol-use disorders, prescription psychoactive drug-use disorders, and other substances: illicit, over-the-counter, and tobacco products. Aging is viewed as a complex process with important cellular-genetic, organismic, psychosocial, and cultural dimensions. The interaction of these processes produces great diversity among individuals. Vulnerability to disease is a function of aging. However, the actual occurrence and manifestations of illness and responses to disease are variable. In affected individuals, substance abuse interacts with, and complicates, all features of aging, illness, and dysfunction. Risk factors for substance-use disorders such as cohort and period effects, biological risk factors, and psychosocial and psychiatric risk factors are also reviewed in the chapter. Special clinical features, social factors, and professional biases contribute to under-recognition of the substance-use disorders in the elderly. The chapter further highlights the principles of assessment and management of these disorders. There is a general need for the information on distinctive gender, ethnic, and socioeconomic patterns of geriatric substance use and abuse to take preventive measures. The chapter also discusses the future prospects, including planning for services and prevention in this regard.

Referral paths, patient profiles and treatment adherence of older alcoholic men

We sought factors affecting completion by older men of 1-year outpatient treatment for alcohol dependence. We retrospectively studied clinical datasets of 110 men, age > or =55 years, consecutively admitted over 4 years, examining the association of 18 referral, treatment and patient variables with completion of treatment. We found that referral source was the most significant correlate of completion. Legal and self/family referrals were far more likely to complete treatment than patients referred by health or social services. Referral groups had distinctive profiles. Legal referrals were the healthiest. Self/family referrals were most likely to be married, to have had prior alcoholism treatment (a factor also associated with treatment completion), and to suffer currently from depression. Health/social services referrals showed the highest levels of psychosocial and physical dysfunction. Referral pathways deserve special consideration by programs treating older alcoholics. Special strategies for engaging dysfunctional older patients in alcoholism treatment are discussed.

OUTCOME OF NURSING HOME CARE FOR RESIDENTS WITH ALCOHOL USE DISORDERS

Objectives. To describe the outcome of nursing home (NH) care for a previously established cohort of residents with active, inactive or no alcohol use disorder (AUD), and to examine demographic variables, health services utilization, mortality and drinking behaviors in this group.

Alcohol Use in Later Life: Scourge, Solace, or Safeguard of Health?

The survey of alcohol use by older adults in Iowa reported in this issue by Schultz and her colleagues raises important questions about the effects of alcohol on health in this age-group. The answer to the question posed in the title of this editorial is that alcohol can be all of these—scourge, solace, and safeguard of health—depending upon the user, the circumstances of use, and the pattern of alcohol consumption. The National Institute on Alcohol Abuse and Alcoholism recommends that healthy older persons limit their drinking to seven standard drinks per week, but a maximum of two drinks per drinking occasion. This may be a bit too restrictive, for there is evidence that regular consumption of up to two drinks per day (14 per week) does have a protective effect against coronary heart disease, about which I will say more in a moment. But it is surely the case that “binge” drinking—consuming more than four or five drinks per occasion—is deleterious to health. It won’t do to imbibe the week’s quota of drinks on a single evening. In fact, fewer than half of older adults drink alcohol at all, though older men are twice as likely to drink as women; and only about one-third of elderly persons drink on more than 12 occasions per year.

Variation Among Aging Alcoholic Patients in Treatment

The authors compared demographic and clinical features of two groups of older patients with alcohol use disorders (n=205 and 124) selected before and after major program changes took place at a clinic designed specifically to treat aging alcoholic patients. Program changes (admission criteria, case-finding practices, treatments offered), significantly altered case-mix and treatment adherence. Results demonstrate variability among older alcoholic patients as well as the impact of program policies and practices on patient profiles and treatment responses.