CONTENTS

Table of Contents
Introduction

1. Overview
2. Recognizing Alcohol Misuse and Abuse in Older Adults
3. Alcohol and Aging
4. Diagnosing Alcohol Problems in Older Adults
5. Recognizing Other Forms of Substance Abuse
6. Prevention and Early Intervention Strategies
7. Treatment
8. Outcomes and Cost Issues in Alcohol Treatment for Older Adults
9. Legal and Ethical Issues

Supplements
Resources

At Any Age, It Does Matter:
Substance Abuse and Older Adults (for Professionals)

Epidemiology of Alcohol Problems Among Older Adults

Problems stemming from alcohol consumption, including interactions of alcohol with prescribed and over-the-counter drugs, far outnumber any other substance abuse problem among older adults. Alcohol abuse and dependence are prevalent but frequently unrecognized conditions in older adults. Of the estimated 10 million alcoholics in the United States, probably 3 million are over the age of 60 years.¹⁹

According to the most recent National Household Survey on Drug Abuse, 5.6 percent of people 65 years and older engaged in binge drinking during the past month and 1.6 percent engaged in heavy alcohol use; 0.5 percent were alcohol dependent.²⁰ The figure below shows alcohol use among older adults.

Alcohol Use Among Adults 65+

Based on current Census figures, these percentages represent 1,951,488 binge drinkers, of whom 557,568 were heavy drinkers; 174,240 were alcohol dependent. Thus, more than 2 million people 65 years and older had some sort of alcohol problem.

Prevalence

Prevalence estimates of problem drinking among older adults in community surveys have ranged from 1 to 15 percent.²¹ These rates vary widely depending on the definition of risk drinking or alcohol abuse/dependence and the methodology used in obtaining samples.

Among clinical populations, estimates of alcohol abuse/dependence are substantially higher. Problem drinkers of all ages are more likely to present themselves in health care settings, especially since they frequently have comorbid conditions.

A recent study found that 15 percent of men and 12 percent of women age 60 and over treated in primary care clinics regularly drank in excess of limits recommended by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).^22-24 According to a recent study by the National Center on Addiction and Substance Abuse, women over the age of 59 are experiencing a hidden epidemic of abuse and addiction. Of the 25.6 million women in this age group, approximately 1.8 million abuse alcohol.²⁵

Among older patients seeking treatment in hospitals, primary care clinics, and nursing homes for medical or psychiatric problems, rates of concurrent alcoholism have been reported to be between 15 and 58 percent.²¹ Surveys indicate that 6 to 11 percent of older patients admitted to hospitals exhibit symptoms of alcoholism, as do 20 percent of older patients in psychiatric wards and 14 percent of older patients in emergency rooms.²⁶

Currently, rates for alcohol-related hospitalizations among older patients are similar to those for heart attacks.²⁷ These rates vary greatly by geographic location, from 19 per 10,000 admissions in Arkansas to 77 per 10,000 in Alaska. The prevalence of alcohol-related hospitalizations among people 65 and older in 1989 was 54.7 per 10,000 for men and 14.8 per 10,000 for women. The hospital-associated charges to Medicare for all admissions in 1989 where the primary diagnosis was alcohol related totaled $233,543,500, with a median charge of $4,514.²⁷

Special Populations

Some studies show the prevalence of problem drinking in nursing homes to be as high as 49 percent, depending in part on survey methods.²⁸ The high prevalence of problem drinking in this setting may reflect a trend toward using nursing homes for short-term alcoholism rehabilitation stays.²⁹ Late-onset alcohol problems also occur in some retirement communities, where drinking at social gatherings is often the norm.³⁰

Some populations may experience alcohol problems at higher rates than the general population. For example, a recent study of older American Indians indicated that among current drinkers, the average score on the Short Michigan Alcoholism Screening Test was in the alcoholic range. In addition, 26 percent of men had engaged in binge drinking, compared to 5.6 percent among all individuals 65 and older.³¹ Additional data on alcohol use among various populations is available in Drinking in the United States: Main Findings from the 1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES).