Concise review for cliniciansGeriatric Alcohol Use Disorder: A Review for Primary Care Physicians
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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2018, American Journal of Geriatric PsychiatryCitation Excerpt :The search terms were “mental health,” “geriatric,” and “veteran” (Supplementary Table S1). We also searched reference lists of included articles and relevant review articles,14,15 Google Scholar, issues of journals, and contacted key authors in the field to find additional studies. Articles had to meet the following inclusion criteria: study group of veterans, defined as any individual who served in the Armed Forces; a sample (N ≥ 450) with a mean age of ≥65 years; and report of current, period, or lifetime estimates of mental health disorder prevalence.
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