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)

Medical Costs of Alcohol-Related Diseases

Disease	Cases Among Persons 65+	Cost
Acute pancreatitis	5,404	$64,447,221
Acute respiratory distress syndrome	213	$1,631,018
Alcohol dependence	22,644	$145,649,051
Aneurysm (subarachnoid hemorrhage)	870	$8,552,201
Assault*	33,975	$14,269,655
Breast cancer	872	$6,953,984
Chronic obstructive pulmonary disease†	11,033	$98,425,728
Chronic pancreatitis	2,550	$30,413,295
Cirrhosis	8,618	$117,368,542
Colorectal cancer	6,562	$84,375,889
Congestive heart failure	33,762	$376,083,458
Depression	22,969	$247,855,966
Diabetes	12,412	$92,298,399
Drug dependence	12,144	$78,113,458
Epilepsy	987	$9,741,605
Esophageal cancer	797	$10,249,973
Falls	474,248	$3,641,089,285
Firearm suicides	1,023	$1,045,760
Fires and burns	29,555	$760,880,060
HIV/AIDS	2,089	$42,806,660
Homicide/suicide	235	$240,226
Hypertension	14,131	$80,623,243
Infective endocarditis‡	2,674	$68,267,230
Laryngeal cancer	739	$9,531,070
Liver cancer	662	$8,665,785
Lung cancer	6,198	$83,372,356
Motor vehicle accidents	297,144	$4,902,559,708
Myocardial infarction	52,129	$713,133,126
Oral leukoplakia§	298	$3,335,624
Oral/pharyngeal cancer	2,210	$28,498,842
Pneumonia	62,057	$616,788,670
Poisonings	2,505	$18,884,943
Sexually transmitted diseases	30,306	$6,136,593
Stroke	54,938	$539,887,550
Traumatic injuries	9,789	$185,127,275
Workplace injuries**	9,310	$7,246,904
TOTAL	1,228,052	$13,104,550,353

Notes

The formula for costs is number of cases x cost per case. Because the cost figures are derived from formulas, some data limitations should be noted.

The number of cases is based on the population attributable risk (PAR). The PAR formula is: [Prevalence x (Relative Risk – 1)/Prevalence x (Relative Risk – 1) + 1] x 100, where prevalence is the percentage of use in the general population and relative risk is an individual substance abuser’s increased risk of contracting a disease relative to that of a non-substance abuser. The formula yields the number of cases related to substance abuse.

The number of cases was multiplied by 12.65 percent, the proportion of persons age 65 and over, to yield the number of cases among older persons. Cost per case is determined based on the average number of hospital days to treat a disease multiplied by the cost per day.

*Assaults by other or unspecified means and assaults by cutting and piercing instrument; does not include fight, brawl, or rape.

^†Figures for chronic obstructive pulmonary disease (COPD) are the same as for acute respiratory distress syndrome. COPD was not noted in the literature, but risks would be similar as COPD can lead to episodes of respiratory distress.

^‡The number of cases of infective endocarditis is based on the population attributable risk (PAR) for injecting drug use but is consistent with research indicating that excess alcohol consumption significantly increases the risk of infective endocarditis. Although no relative risk figures were available, the relative risk figure corresponding to the prevalence and PAR would be approximately 1.8, a conservative number given the high risk of heart attack (myocardial infarction).

^§Oral leukoplakia is used as a proxy measure for alcohol-related dental problems. Literature is sparse regarding the effects of alcohol on dental health, such as edentulousness, gingivitis, and decay.

**No. of cases = Total injuries x % of workers 65+.

Sources

Number of Cases

• American Cancer Society.
• Brain Aneurysm Foundation. Brain Aneurysm Report, Winter 1995-96, page 1.
• Centers for Disease Control and Prevention. 1997 Sexually Transmitted Disease Surveillance Report.
• Cosgrove, C. "Murder-Suicides in Elderly Rise." WebMD, 1999.
• Hall, M., and Popovic, J. 1998 Summary: National Hospital Discharge Survey. Vital and Health Statistics Series, Advance Data Number 316, June 30, 2000.
• Lawrence, L., and Hall, M. 1997 Summary: National Hospital Discharge Survey. Vital and Health Statistics Series, Advance Data Number 308, August 18, 1999.
• McCaig, L. National Ambulatory Medical Care Survey: 1998 Emergency Department Summary. Vital and Health Statistics Series, Advance Data Number 313, May 10, 2000.
• McCaig, L. National Hospital Ambulatory Medical Care Survey: 1992 Emergency Department Summary. Vital and Health Statistics Series, Advance Data Number 245, March 2, 1994.
• Recommended framework for presenting injury mortality data. MMWR, August 29, 1997, Vol. 46, RR-14.
• Wagener, D.; Walstedt, J.; Jenkins, L.; et al. Women: Work and Health. Vital and Health Statistics Series 3, Number 31, December 1997.

Hospital Stay and Costs

• Fong, L.P. Eye injuries in Victoria, Australia. Medical Journal of Australia 1995, 162(2):64-68.
• Grimm, D.J., and Fallat, L. Injuries of the foot and ankle in occupational medicine: A 1-year study. Journal of Foot and Ankle Surgery 1999, 38(2):102-108.
• Health Care Financing Administration, Bureau of Data Management and Strategy, from the 100% Medicare Provider Analysis and Review inpatient hospital fiscal year 1998, 12/15/98 update, short stay inpatient by diagnosis related group; DRG description file.
• Health Care Financing Administration, National Physician Fee Schedule Payment Amount File, Calendar Year 2000.
• Ordog, G.J.; Wasserberger, J.; and Ackroyd, G. Hospital costs of firearm injuries. Journal of Trauma 1995, 38(2):291-298.
• Waller, J.A.; Skelly, J.M.; and Davis, J.H. Characteristics, costs, and effects of violence in Vermont. Journal of Trauma 1994, 37(6):921-927.

Prevalence

Office of Applied Studies. Summary of Findings from the 1999 National Household Survey on Drug Abuse. Rockville, Maryland: Substance Abuse and Mental Health Services Administration, August 2000.

Relative Risk and PAR

• Baron, J.A.; Sandler, R.S.; Haile, R.W.; et al. Folate intake, alcohol consumption, cigarette smoking, and risk of colorectal adenomas. Journal of the National Cancer Institute 1998, 90(1):57-62.
• Berger, K.; Ajani, U.A.; Kase, C.S.; et al. Light-to-moderate alcohol consumption and risk of stroke among U.S. male physicians. New England Journal of Medicine 1999, 341(21):1557-1564.
• Carpenter, C.L.; Morganstern, H.; and London, S.J. Alcoholic beverage consumption and lung cancer risk among residents of Los Angeles County. Journal of Nutrition 1998, 128(4):694-700.
• English, D., et al. The Quantification of Drug Caused Morbidity and Mortality in Australia, Part 1 and 2. Commonwealth Department of Human Services and Health, Australian Government Printing Service.
• English, D.R.; Holman, C.D.J.; Milne, E.; et al. "The Quantification of Morbidity and Mortality Caused by Substance Abuse." Prepared for the Second International Symposium on the Social and Economic Costs of Substance Abuse, October 2-5, 1995.
• Golding, J.M.; Burnam, M.A.; Benjamin, B.; et al. Risk factors for secondary depression among Mexican Americans and non-Hispanic whites. Alcohol use, alcohol dependence, and reasons for drinking. Journal of Nervous and Mental Disease 1993, 181(3):166-175.
• Holbrook, T.L.; Barrett-Connor, E.; and Wingard, D.L. A prospective population-based study of alcohol use and non-insulin-dependent diabetes mellitus. American Journal of Epidemiology 1990, 132(5):902-909.
• Kauhanen, J.; Kaplan, G.A.; Goldberg, D.E.; et al. Beer bingeing and mortality: Results from the Kuopio ischaemic heart disease risk factor study, a prospective population based study. British Medical Journal 1997, 315(7112):846-851.
• Kjaerheim, K.; Gaard, M.; and Andersen, A. The role of alcohol, tobacco, and dietary factors in upper aerogastric tract cancers: A prospective study of 10,900 Norwegian men. Cancer Causes and Control 1998, 9(1):99-108.
• Komajda, M.; Richard, J.L.; Bouhour, J.B.; et al. Dilated cardiomyopathy and the level of alcohol consumption: A planned multicentre case-control study. European Heart Journal 1986, 7(6):512-519.
• Longstreth, W.T., Jr.; Nelson, L.M.; Koepsell, T.D.; et al. Cigarette smoking, alcohol use, and subarachnoid hemorrhage. Stroke 1992, 23(9):1242-1249.
• Mcleod, R.; Stockwell, T.; Stevens, M.; et al. The relationship between alcohol consumption patterns and injury. Addiction 1999, 94(11):1719-1734.
• Moreira, L.B.; Fuchs, F.D.; Moraes, R.S.; et al. Alcohol intake and blood pressure: The importance of time elapsed since last drink. Journal of Hypertension 1998, 16(2):175-180.
• Moss, M.; Bucher, B.; Moore, F.A.; et al. The role of chronic alcohol abuse in the development of acute respiratory distress syndrome in adults. JAMA 1996, 275(1):50-54.
• National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism. The Economic Costs of Alcohol and Drug Abuse in the United States—1992. (Accessed on the Internet at http://www.nida.nih.gov/economiccosts/Table4_9.html)
• Rohan, T.E.; Jain, M.; Howe, G.R.; et al. Alcohol consumption and risk of breast cancer: A cohort study. Cancer Causes and Control 2000, 11(3):239-247.
• Ruiz, M.; Ewig, S.; Torres, A.; et al. Severe community-acquired pneumonia. Risk factors and follow-up epidemiology. American Journal of Respiratory Critical Care Medicine 1999, 160(3):923-929.
• Swendsen, J.D.; Merikanagas, K.R.; Canino, G.J.; et al. The comorbidity of alcoholism with anxiety and depressive disorders in four geographic communities. Comprehensive Psychiatry 1998, 39(4):176-184.
• Wingood, G.M., and DiClemente, R.J. The influence of psychosocial factors, alcohol, drug use on African-American women's high-risk sexual behavior. American Journal of Preventive Medicine 1998, 15(1):54-59.
• Zambon, P.; Talamini, R.; La Vecchia, C.; et al. Smoking, type of alcoholic beverage and squamous-cell oesophageal cancer in northern Italy. International Journal of Cancer 2000, 86(1):144-149.
• Zodpey, S.P.; Tiwari, R.R.; and Kulkarni, H.R. Risk factors for haemorrhagic stroke: A case-control study. Public Health 2000, 114(3):177-182.

PAR Formula

• Fox, K.; Merrill, J.C.; Chang, H.H.; et al. Estimating the costs of substance abuse to the Medicaid hospital care program. American Journal of Public Health 1995, 85(1):48-54.

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