Concise review for clinicians
Geriatric Alcohol Use Disorder: A Review for Primary Care Physicians

https://doi.org/10.1016/j.mayocp.2015.03.012Get rights and content

Abstract

Alcohol use disorder in the geriatric population is a growing public health problem that is likely to continue to increase as the baby boomer generation ages. Primary care providers play a critical role in the recognition and management of these disorders. This concise review will focus on the prevalence, risk factors, screening, and clinical management of geriatric alcohol use disorder from a primary care perspective.

Section snippets

Etiology and Risk Factors

Alcohol use disorder can be a lifelong illness with early onset and recurrences or relapses into old age. However, AUD can also occur for the first time late in life in the setting of major life changes. The specific cause of late life–onset AUD is unclear, although known biological and psychological risk factors and major life events or psychosocial stressors later in life may play a role. There is strong evidence for genetic factors associated with AUD. Children of alcoholic parents have

AUD and Cognitive Impairment

Heavy alcohol consumption has negative effects on cognitive function, which is a particular concern in the elderly. Wernicke encephalopathy is an acute neurologic condition from thiamine deficiency characterized by a classic triad of ophthalmoplegia, gait ataxia, and confusion. However, patients rarely present with this classic triad, and the absence of 1 or more of the classic symptoms leads to underdiagnosis, missed treatment with thiamine to reverse the condition, and subsequent challenges

Screening for AUD in the Primary Care Setting

The 2 previously distinct disorders alcohol abuse and alcohol dependence in DSM-IV21 are now integrated into the single DSM-5 item AUD. A diagnosis of AUD can be made if any 2 of the 11 criteria (larger amount of alcohol use over a longer period than intended; unable to cut down or control alcohol use; significant amount of time spent to obtain alcohol; craving; impairment in work, school, or home activities; continued use despite problems; important activities are given up; use in physically

Clinical Management

The most important step in managing AUD in geriatric patients is to identify it. Stabilizing the patient medically and psychiatrically is essential by actively managing medical comorbidities, ensuring a safe detoxification and withdrawal process, and addressing severe mood, anxiety, psychotic, or cognitive issues. Only when stable from the medical and psychiatric perspectives can AUD be fully addressed with a biopsychosocial approach.

Conclusion

Geriatric AUD has long been an overlooked public health phenomenon that increasingly poses a challenge to the health care system. Primary care providers play a critical role in the recognition and treatment of AUD in older adults. Unique biopsychosocial factors facing older adults make AUD in this population different from that in their younger counterparts. Risk factors in older adults include being a white male, being widowed/divorced, being aged 65 to 74 years, and the presence of financial

Acknowledgments

We thank Leah Osterhaus Trzasko, MLIS, for her work in conducting a literature review on the recent work being performed on geriatric AUD.

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