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

Module 2: Recognizing Alcohol Misuse and Abuse in Older Adults - Page 13 of 16

Difficulties Diagnosing Alcohol Problems in Older Adults

Complicating Diagnostic Factors

Diagnosis tends to be more complicated in older persons. Separating alcohol-related health problems from the effects of medication and coexisting chronic illness can be difficult. The coexistence of nonalcohol-related dementia, depression, and other medical problems and the use of multiple medications can complicate diagnosis. Alcohol or drug abuse may mimic other conditions:

Alcohol problems, diseases and complications of aging, and adverse drug reactions can all have similar symptoms, including:

A procedure for differential diagnosis between alcohol and drug problems and other disorders, such as depression, is necessary. (See Module 4, Diagnosing Alcohol Problems in Older Adults.)

Lack of Adequate Assessment Tools

Most traditional assessment tools were designed for and validated on younger adults in a mainstream lifestyle. Indicators of alcohol and drug abuse in younger adults may not be as relevant to older persons. Assessments that rely on self-reports are a problem because older adults are even less likely than younger adults to realize or admit they have a drinking problem.

Diagnostic Criteria That May Not Be Age Appropriate

Criteria that work well in detecting alcohol problems of younger people may not work well with older adults, due to changing life, family, and occupation patterns, as well as other changes of aging. See Module 4 for more on screening and screening tools. The exercise looks at several common diagnostic criteria and why they may not work with older people.

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