Alcohol related disorders in people over 65

There is evidence that alcohol misuse in people over the age of 65 is increasing, especially in women. Although estimates vary, in one study, the prevalence of alcohol dependence in patients over the age of 60 admitted to hospital was 15 percent.

For a variety of reasons, alcohol misuse may go unnoticed in this age group.

Alcohol misuse may be suspected if, for example, there are unexplained falls and fractures, hypertension, confusional episodes, late onset epilepsy, or failure to maintain previous standards of dress or behaviour.

People over the age of 65 years have a lower tolerance to the effects of alcohol and this may result in the confusion associated with intoxication or withdrawal lasting longer than in younger people.

Alcohol misuse is associated with:

• Increased risk of stroke, subdural haematoma (blood clots in the brain) and infection
• Memory loss
• Hypertension
• Peripheral neuropathy
• Dementia
• Depression, associated with a high risk of suicide
• Symptoms of elation, leading to a diagnosis of mania
• Hallucinations, leading to a diagnosis of psychosis
• Withdrawal fits, leading to a diagnosis of epilepsy
• Confusion, sometimes exacerbated by prescription of multiple medications

The signs and symptoms necessary for a diagnosis of alcohol dependence are the same as for a younger age group, but they may present in unusual ways. For example, cognitive impairment may persist for up to a month following the acute withdrawal syndrome.

Treatment is similar to that for a younger age group, with some minor differences. For example, the death rate in untreated withdrawal syndrome is high at 10 to 15 percent, and must be considered a medical emergency.