Skip to main content
Erschienen in: Current Geriatrics Reports 3/2021

24.07.2021 | Geriatric Psychiatry (S Lehmann, Section Editor)

Evaluation and Management of Alcohol use Disorder among Older Adults

verfasst von: Pallavi Joshi, Karen T Duong, Louis A. Trevisan, Kirsten M. Wilkins

Erschienen in: Current Geriatrics Reports | Ausgabe 3/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

The prevalence of alcohol use disorder (AUD) among older adults in the United States is rising, but remains underdiagnosed, underreported, and inadequately managed. This review highlights the medical, social, and cultural factors of AUD in older adults and provides guidelines for its screening, evaluation, and management.

Recent Findings

The COVID-19 pandemic has created additional challenges and barriers to care, as older adults may have disproportionate worsening of anxiety, depression, and substance use resulting from increased isolation related to physical distancing and shelter-in-place guidelines.

Summary

All older adults should be routinely screened for AUD with standardized screening tools. If a patient’s screening results are positive, a clinician should conduct a brief assessment, which may be supplemented by laboratory tests. Most older adults at risk for alcohol misuse do not need specialized SUD treatment, but most can benefit from Screening, Brief Intervention, and Referral to Treatment (SBIRT) to prevent substance misuse before it occurs. Medications for the treatment of AUD in older adults include naltrexone, acamprosate, disulfiram, gabapentin and topiramate. Psychosocial treatments, including mutual help groups, are equally important.
Literatur
1.
Zurück zum Zitat Center for Behavioral Health Statistics and Quality (2020). Results from the 2019 National Survey on drug use and health: detailed tables. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from www.samhsa.gov/data/ Center for Behavioral Health Statistics and Quality (2020). Results from the 2019 National Survey on drug use and health: detailed tables. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from www.​samhsa.​gov/​data/​
2.
Zurück zum Zitat Grant BF, Goldstein RB, Saha TD, Chou SP, Jung J, Zhang H, et al. The epidemiology of DSM-5 alcohol use disorder: results from the National Epidemiologic Survey on alcohol and related conditions, III. JAMA Psychiatry. 2015;72:757–66. Grant BF, Goldstein RB, Saha TD, Chou SP, Jung J, Zhang H, et al. The epidemiology of DSM-5 alcohol use disorder: results from the National Epidemiologic Survey on alcohol and related conditions, III. JAMA Psychiatry. 2015;72:757–66.
3.
Zurück zum Zitat Substance Abuse and Mental Health Services Administration. Improving cultural competence. Treatment improvement protocol (TIP) series 59. HHS publication no. (SMA) 14–4849: Substance Abuse and Mental Health Services Administration; 2014. Substance Abuse and Mental Health Services Administration. Improving cultural competence. Treatment improvement protocol (TIP) series 59. HHS publication no. (SMA) 14–4849: Substance Abuse and Mental Health Services Administration; 2014.
4.•
Zurück zum Zitat Yarnell S, Li L, Mac Grory B, et al. Substance Use Disorders in Later Life: A Review and Synthesis of the Literature of an Emerging Public Health Concern. The American Journal of Geriatric Psychiatry. 2020;28:226–36. This review paper provides a timely overview of the literature on substance use disorders among older adults.CrossRef Yarnell S, Li L, Mac Grory B, et al. Substance Use Disorders in Later Life: A Review and Synthesis of the Literature of an Emerging Public Health Concern. The American Journal of Geriatric Psychiatry. 2020;28:226–36. This review paper provides a timely overview of the literature on substance use disorders among older adults.CrossRef
7.
Zurück zum Zitat Taylor MH, Grossberg GT (2012). The growing problem of illicit substance abuse in the elderly: a review. Primary Care Companion for CNS Disorders, 14(4). Taylor MH, Grossberg GT (2012). The growing problem of illicit substance abuse in the elderly: a review. Primary Care Companion for CNS Disorders, 14(4).
8.•
Zurück zum Zitat Satre DD, Hirschtritt ME, Silverberg MJ, Sterling SA. Addressing Problems with Alcohol and Other Substances Among Older Adults During the COVID-19 Pandemic. Am J Geriatr Psychiatry. 2020 Jul;28(7):780–783. https://doi.org/10.1016/j.jagp.2020.04.012. Epub 2020 Apr 22. PMID: 32359882; PMCID: PMC7174977. This article provides COVID-19 specific updates to the literature on alcohol use disorder among older adults. Satre DD, Hirschtritt ME, Silverberg MJ, Sterling SA. Addressing Problems with Alcohol and Other Substances Among Older Adults During the COVID-19 Pandemic. Am J Geriatr Psychiatry. 2020 Jul;28(7):780–783. https://​doi.​org/​10.​1016/​j.​jagp.​2020.​04.​012. Epub 2020 Apr 22. PMID: 32359882; PMCID: PMC7174977. This article provides COVID-19 specific updates to the literature on alcohol use disorder among older adults.
12.
Zurück zum Zitat Office of the Surgeon General. Facing addiction in America: the surgeon General’s report on alcohol, drugs, and health: Department of Health and Human Services; 2016. Office of the Surgeon General. Facing addiction in America: the surgeon General’s report on alcohol, drugs, and health: Department of Health and Human Services; 2016.
13.
Zurück zum Zitat Schulte MT, Hser YI. Substance use and associated health conditions throughout the lifespan. Public Health Rev. 2014;35(2):ii. Schulte MT, Hser YI. Substance use and associated health conditions throughout the lifespan. Public Health Rev. 2014;35(2):ii.
14.•
Zurück zum Zitat Substance Abuse and Mental Health Services Administration. Treating Substance Use Disorder in Older Adults. Treatment Improvement Protocol (TIP) Series 26. HHS Publication No. PEP20–02–01-011: Substance Abuse and Mental Health Services Administration; 2020. This highly important reference includes SAMHSA’s 2020 recommendations regarding evaluation and management of various substance use disorders among older adults. Substance Abuse and Mental Health Services Administration. Treating Substance Use Disorder in Older Adults. Treatment Improvement Protocol (TIP) Series 26. HHS Publication No. PEP20–02–01-011: Substance Abuse and Mental Health Services Administration; 2020. This highly important reference includes SAMHSA’s 2020 recommendations regarding evaluation and management of various substance use disorders among older adults.
15.
Zurück zum Zitat U.S. Preventive Services Task Force. (2018). Final recommendation statement: Unhealthy alcohol use in adolescents and adults: Screening and behavioral counseling interventions. U.S. Preventive Services Task Force. (2018). Final recommendation statement: Unhealthy alcohol use in adolescents and adults: Screening and behavioral counseling interventions.
18.
Zurück zum Zitat Barbor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG (2001). AUDIT: the alcohol use disorders identification test: guidelines for use in primary care (2nd ed., p. 17). Geneva, Switzerland: World Health Organization. Barbor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG (2001). AUDIT: the alcohol use disorders identification test: guidelines for use in primary care (2nd ed., p. 17). Geneva, Switzerland: World Health Organization.
19.
Zurück zum Zitat Selin KH. Test-retest reliability of the alcohol use disorder identification test in a general population sample. Alcohol Clin Exp Res. 2003;27(9):1428–35.CrossRef Selin KH. Test-retest reliability of the alcohol use disorder identification test in a general population sample. Alcohol Clin Exp Res. 2003;27(9):1428–35.CrossRef
20.
Zurück zum Zitat Purcell B, Olmstead MC. The performance and feasibility of three brief alcohol screening tools in a senior population. Can Psychol. 2014;55(2a):19. Purcell B, Olmstead MC. The performance and feasibility of three brief alcohol screening tools in a senior population. Can Psychol. 2014;55(2a):19.
21.
Zurück zum Zitat Aalto M, Alho H, Halme JT, Seppä K. The alcohol use disorders identification test (AUDIT) and its derivatives in screening for heavy drinking among the elderly. International Journal of Geriatric Psychiatry. 2011;26(9):881–5.CrossRef Aalto M, Alho H, Halme JT, Seppä K. The alcohol use disorders identification test (AUDIT) and its derivatives in screening for heavy drinking among the elderly. International Journal of Geriatric Psychiatry. 2011;26(9):881–5.CrossRef
22.
Zurück zum Zitat Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory care quality improvement project (ACQUIP). Arch Intern Med. 1998;158:1789–95.CrossRef Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory care quality improvement project (ACQUIP). Arch Intern Med. 1998;158:1789–95.CrossRef
23.
Zurück zum Zitat Purcell B, Flower MC, Busto U. (2017). Senior alcohol misuse Indicator (SAMI) tool. Centre for Addiction and Mental Health. Purcell B, Flower MC, Busto U. (2017). Senior alcohol misuse Indicator (SAMI) tool. Centre for Addiction and Mental Health.
24.
Zurück zum Zitat Blow FC, et al. Brief screening for alcohol problems in elderly populations using the short Michigan alcoholism screening test-geriatric version (SMAST-G): Research Society on Alcoholism Annual Scientific Meeting; 1998. Blow FC, et al. Brief screening for alcohol problems in elderly populations using the short Michigan alcoholism screening test-geriatric version (SMAST-G): Research Society on Alcoholism Annual Scientific Meeting; 1998.
25.
29.
Zurück zum Zitat Friedrichs A, Spies M, Härter M, Buchholz A. Patient preferences and shared decision making in the treatment of substance use disorders: a systematic review of the literature. PLoS One. 2016;11(1):e0145817.CrossRef Friedrichs A, Spies M, Härter M, Buchholz A. Patient preferences and shared decision making in the treatment of substance use disorders: a systematic review of the literature. PLoS One. 2016;11(1):e0145817.CrossRef
30.
Zurück zum Zitat Schutte K, Lemke S, Moos RH, Brennan PL. Age-sensitive psychosocial treatment for older adults with substance abuse. In: Crome I, Wu L-T, Rao RT, Crome P, editors. Substance use and older people: Wiley-Blackwell; 2015. p. 314–39. Schutte K, Lemke S, Moos RH, Brennan PL. Age-sensitive psychosocial treatment for older adults with substance abuse. In: Crome I, Wu L-T, Rao RT, Crome P, editors. Substance use and older people: Wiley-Blackwell; 2015. p. 314–39.
31.
Zurück zum Zitat Kuerbis A, Sacco P. A review of existing treatments for substance abuse among the elderly and recommendations for future directions. Subst Abus. 2013;7:13–37. Kuerbis A, Sacco P. A review of existing treatments for substance abuse among the elderly and recommendations for future directions. Subst Abus. 2013;7:13–37.
32.
Zurück zum Zitat National Guardianship Association. (2013). Standards of practice (4th ed.). Retrieved from www.guardianship. org/wp-content/uploads/2017/07/NGA-Standards-with-Summit-Revisions-2017.pdf. National Guardianship Association. (2013). Standards of practice (4th ed.). Retrieved from www.​guardianship. org/wp-content/uploads/2017/07/NGA-Standards-with-Summit-Revisions-2017.pdf.
33.
Zurück zum Zitat Wilkins JM. Dementia, decision making, and quality of life. AMA J Ethics. 2017;19:637–9.CrossRef Wilkins JM. Dementia, decision making, and quality of life. AMA J Ethics. 2017;19:637–9.CrossRef
34.
Zurück zum Zitat Bommersbach TJ, Lapid MI, Rummans TA, Morse RM. Geriatric alcohol use disorder: a review for primary care physicians. Mayo Clin Proc. 2015;90(5):659–66.CrossRef Bommersbach TJ, Lapid MI, Rummans TA, Morse RM. Geriatric alcohol use disorder: a review for primary care physicians. Mayo Clin Proc. 2015;90(5):659–66.CrossRef
35.
Zurück zum Zitat Oslin DW, Zanjani F. (2016). Treatment of unhealthy alcohol use in older adults. Alcohol and aging: clinical and public health perspectives (pp. 181–199). New York, NY: springer. Oslin DW, Zanjani F. (2016). Treatment of unhealthy alcohol use in older adults. Alcohol and aging: clinical and public health perspectives (pp. 181–199). New York, NY: springer.
36.
Zurück zum Zitat Substance Abuse and Mental Health Services Administration and National Institute on Alcohol Abuse and Alcoholism. Medication for the treatment of alcohol use disorder: a brief guide. HHS publication no. (SMA) 15–4907: Substance Abuse and Mental Health Services Administration; 2015. Substance Abuse and Mental Health Services Administration and National Institute on Alcohol Abuse and Alcoholism. Medication for the treatment of alcohol use disorder: a brief guide. HHS publication no. (SMA) 15–4907: Substance Abuse and Mental Health Services Administration; 2015.
37.
Zurück zum Zitat Winslow BT, Onysko M, Hebert M. Medications for alcohol use disorder. Am Fam Physician. 2016;93(6):457–65.PubMed Winslow BT, Onysko M, Hebert M. Medications for alcohol use disorder. Am Fam Physician. 2016;93(6):457–65.PubMed
38.
Zurück zum Zitat Sinclair J, Chambers S, Shiles C, Baldwin DS. Safety and tolerability of pharmacological treatment of alcohol dependence: comprehensive review of evidence. Drug Saf. 2016;39:627–45.CrossRef Sinclair J, Chambers S, Shiles C, Baldwin DS. Safety and tolerability of pharmacological treatment of alcohol dependence: comprehensive review of evidence. Drug Saf. 2016;39:627–45.CrossRef
39.
Zurück zum Zitat Mooney LJ, McCance-Katz EF. (2016). Psychopharmacological treatments. Clinical textbook of addictive disorders (4th ed., pp. 668–694). New York, NY: Guilford press. Mooney LJ, McCance-Katz EF. (2016). Psychopharmacological treatments. Clinical textbook of addictive disorders (4th ed., pp. 668–694). New York, NY: Guilford press.
40.
Zurück zum Zitat Hassell C, Wilkins K, Trevisan LA. Pharmacology of geriatric substance use disorders: considerations and future directions. Current Treatment Options in Psychiatry. 2017;4(1):102–15.CrossRef Hassell C, Wilkins K, Trevisan LA. Pharmacology of geriatric substance use disorders: considerations and future directions. Current Treatment Options in Psychiatry. 2017;4(1):102–15.CrossRef
41.
Zurück zum Zitat Le Roux C, Tang Y, Drexler K. Alcohol and opioid use disorder in older adults: neglected and treatable illnesses. Current Psychiatry Reports. 2016;18:87.CrossRef Le Roux C, Tang Y, Drexler K. Alcohol and opioid use disorder in older adults: neglected and treatable illnesses. Current Psychiatry Reports. 2016;18:87.CrossRef
42.
Zurück zum Zitat Lal R, Pattanayak RD. Alcohol use among the elderly: issues and considerations. Journal of Geriatric Mental Health. 2017;4(1):4–10.CrossRef Lal R, Pattanayak RD. Alcohol use among the elderly: issues and considerations. Journal of Geriatric Mental Health. 2017;4(1):4–10.CrossRef
44.
Zurück zum Zitat Witkiewitz K, Saville K, Hamreus K. Acamprosate for treatment of alcohol dependence: mechanisms, efficacy, and clinical utility. Ther Clin Risk Manag. 2012;8:45–53.CrossRef Witkiewitz K, Saville K, Hamreus K. Acamprosate for treatment of alcohol dependence: mechanisms, efficacy, and clinical utility. Ther Clin Risk Manag. 2012;8:45–53.CrossRef
45.
Zurück zum Zitat Puzantian T, Carlat D. Medication fact book for psychiatric practice. 3rd ed. Newburyport, Massachusetts: Carlat Publishing; 2016. Puzantian T, Carlat D. Medication fact book for psychiatric practice. 3rd ed. Newburyport, Massachusetts: Carlat Publishing; 2016.
48.
Zurück zum Zitat Jose NA, Yadav P, Kapoor A, Mahla VP. Comparison between baclofen and topiramate in alcohol dependence: a prospective study. Ind Psychiatry J. 2019;28:44–50.CrossRef Jose NA, Yadav P, Kapoor A, Mahla VP. Comparison between baclofen and topiramate in alcohol dependence: a prospective study. Ind Psychiatry J. 2019;28:44–50.CrossRef
50.
Zurück zum Zitat Satre DD, Chi FW, Mertens JR, Weisner CM. Effects of age and life transitions on alcohol and drug treatment outcome over nine years. Journal of Studies on Alcohol and Drugs. 2012;73(3):459–68.CrossRef Satre DD, Chi FW, Mertens JR, Weisner CM. Effects of age and life transitions on alcohol and drug treatment outcome over nine years. Journal of Studies on Alcohol and Drugs. 2012;73(3):459–68.CrossRef
51.
Zurück zum Zitat Nicholson NR. A review of social isolation: an important but underassessed condition in older adults. J Prim Prev. 2012;33(2–3):137–52.CrossRef Nicholson NR. A review of social isolation: an important but underassessed condition in older adults. J Prim Prev. 2012;33(2–3):137–52.CrossRef
Metadaten
Titel
Evaluation and Management of Alcohol use Disorder among Older Adults
verfasst von
Pallavi Joshi
Karen T Duong
Louis A. Trevisan
Kirsten M. Wilkins
Publikationsdatum
24.07.2021
Verlag
Springer US
Erschienen in
Current Geriatrics Reports / Ausgabe 3/2021
Elektronische ISSN: 2196-7865
DOI
https://doi.org/10.1007/s13670-021-00359-5

Weitere Artikel der Ausgabe 3/2021

Current Geriatrics Reports 3/2021 Zur Ausgabe

Geriatric Psychiatry (S Lehmann, Section Editor)

Review of Grief Therapies for Older Adults

Geriatric Psychiatry (S Lehmann, Section Editor)

“Evaluating and Managing Tardive Dyskinesia in the Older Adult”

Geriatric Urology (H Richter and C Parker-Autry, Section Editors)

Urinary Incontinence in People Living with Cognitive Impairment

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.