Assessing alcohol problems in older adults​

Limitations of diagnostic criteria

In the previous edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), criteria for alcohol dependence were developed with younger adults in mind. This made the disorder more difficult to diagnose in older adults because some of the criteria were inappropriate for an older population. For example:

• occupational disruption – an older adult may be retired
• recurrent social/interpersonal problems – an older adult may be socially isolated for reasons other than alcohol-related problems
• legal difficulties, such as driving impaired – an older adults may no longer drive for other reasons.

The DSM-5 has attempted to remedy some of these limitations in its revised diagnostic criteria for the renamed alcohol use disorder by removing the legal difficulties criterion.

Components of an alcohol problem assessment with older adults

An assessment of an older adult with an alcohol problem should include:

• an assessment of the person's alcohol use history and consequences of use, as well as other drug use history and mental health history
• the Alcohol Use Disorders Identification Test (AUDIT) to collect information about drinking frequency and quantity
• an assessment of the person's ability to live independently using the Assessment of Living Skills and Resources(ALSAR) tool
• an assessment of the person's ability to drive
• referral for an assessment by an occupational therapist, if appropriate
• collateral information from family, friends and other health care providers (with the consent of the patient), especially if cognitive deficits make it difficult to obtain a history from the patient directly.

Medical complications caused by alcohol use

Older adults, particularly women, can experience medical complications from smaller amounts of alcohol compared to younger adults.

Medical complications from alcohol may occur even when the person does not meet criteria for an alcohol use disorder.

Older adults with alcohol problems are at increased risk of:

• further slowing of age-related delayed reaction times and worsening of age-related inco-ordination, resulting in increased incidence of trauma related to falls and other accidents
• alcohol-related dementia and Wernicke-Korsakoff syndrome, which is characterized by memory deficits, ataxia and nystagmus
• malnutrition
• thiamine deficiency, due to both alcohol consumption and malnutrition
• hypertension, cardiac arrhythmias, myocardial infarction and cardiomyopathy
• hemorrhagic stroke
• impaired immune system and capability to combat infection and cancer
• cirrhosis and other liver diseases
• decreased bone density
• gastrointestinal bleeding
• depression, anxiety and other mental health problems
• drug–alcohol interactions, multi-drug overdose (older adults often take more prescription medications than younger people)
• worsening of other chronic illnesses
• worsened age-related reduction in sleep quality (sleep problems may also trigger late-life alcohol problems).