Magazine article Clinical Psychiatry News

Alcohol Abuse among the Elderly Is Serious Problem: Comorbid Disorders Such as Depression Are More Common in Older Alcoholics. (Big Impact on Cognitive Function)

Magazine article Clinical Psychiatry News

Alcohol Abuse among the Elderly Is Serious Problem: Comorbid Disorders Such as Depression Are More Common in Older Alcoholics. (Big Impact on Cognitive Function)

Article excerpt

HONOLULU -- Problem drinking among the elderly is prevalent and has a significant impact on cognitive function and quality of life, speakers said at the annual meeting of the American Association for Geriatric Psychiatry.

Of 408 patients evaluated at the geriatric assessment center at the University of Nebraska Medical Center over 3.5 years, 89 (22%) were classified as problem drinkers based on interviews with a geriatric psychiatrist and their history of alcohol use, Dr. William J. Burke and his colleagues reported. All patients, whose average age was 79 years, answered the neuropsychiatric index (NPI) questionnaire and underwent the Mini-Mental State Examination (MMSE), which measures cognitive function. Compared with those who were not problem drinkers, all of the problem drinkers scored higher on the NPI, suggesting a greater degree of psychopathology especially within the domains of agitation, depression, disinhibition, irritability, and sleep.

Of 138 patients with normal cognitive function, defined as a score greater than or equal to 24 on the MMSE, the 34 problem drinkers had significantly more agitation, apathy disinhibition, and irritability, compared with those without a drinking problem. Among the remaining 270 patients, the 55 problem drinkers scored higher in the domains of disinhibition, irritability, and sleep disturbances. Current and former problem drinkers had similar types and frequencies of behavioral disturbances.

The frequency of behavioral disturbances also was similar among problem drinkers regardless of their MMSE scores, and to those without a drinking problem who scored less than 24 on the MMSE, suggesting that even if their cognitive function is normal, older problem drinkers may have behavioral problems like those seen in patients with dementia. "The lower the non-problem drinkers scored on the MMSE, the greater their number of behavioral problems and the more they started to look like the higher-functioning problem drinkers," Dr. Burke said in an interview.

The number of current and former problem drinkers who had never been identified as such before coming to the assessment center was startling, said Dr. Burke, professor and director of geriatric psychiatry at the University of Nebraska, Omaha. He said he was also surprised at how many patients were still imbibing. "Essentially, nothing is known about how to get them to stop drinking."

Indeed, the public health implications of alcoholism in the elderly have been virtually ignored, Dr. David Oslin said in a symposium on late-life alcohol abuse. Certain comorbid disorders, most notably depression, become more common in older alcoholics and exacerbate functional problems even more. In a study of 22,463 adult alcoholics seeking treatment in the Veterans Administration mental health system over a 1-month period, adaptive function was severely impaired in 20% of those aged 60-69 years who had no comorbid disorders, compared with 40% of those in the same age group who were also depressed. Similar findings were seen in patients older than 69 years (Hosp. Community Psychiatry 43[10]:990-95, 1992.

Conventional wisdom dictates that the two conditions should be treated sequentially, usually alcohol dependence first, then the depression, said Dr. Oslin of the departments of geriatric and addiction psychiatry at the University of Pennsylvania, Philadelphia.

However, the two conditions are so closely intertwined that ignoring one could affect treatment outcomes for the other. …

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