Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

400 IV. SPECIAL POPULATIONSI (Zimberg, 1996) conducted a pilot study of identified elderly alcoholicson a medical service in a New York City hospital. Of the 15 patients interviewed,all answered “yes” to questions 1 and 3 of the CAGE. In addition, allhad abnormal MCV or MCH and/or abnormal liver function tests. Thus, thesepatients could be readily identified in a medical setting.The other area of concern regarding diagnosis of elderly alcoholics is thelack of diagnostic signs so common in younger alcoholics, as I indicated earlier.I developed a list of key questions that can be asked of patients and their families(Zimberg, 1995). These questions are listed in Table 18.1. As can be seen,the questions relate to behavioral, cognitive, social, and activities of daily livingthat can be seriously affected by excessive alcohol consumption in a elderlyindividual. The use of benzodiazepines is also commonly seen in such patients.An accident or a fall can be the precipitating event that brings the alcoholproblem to the attention of family members and, if serious enough, result inhospitalization (Surock & Shimkin, 1988).Therefore, the ability to diagnose an alcohol problem in an older person ispossible and relatively easy to accomplish. The use of the CAGE, laboratorytesting, and the use of the key questions with the patient and with family canfacilitate this diagnostic process. Since the evidence of a relatively high prevalenceof alcohol problems in the elderly has been established, it is necessary toincrease the index of suspicion among health care professionals, utilizing thediagnostic tools indicated to make the diagnosis and engage the patient intreatment or referral for treatment.The other diagnostic concern with the elderly alcoholics in looking forTABLE 18.1. Approach to Interview and Assessment1. Has there been any recent marked change in behavior or personality?2. Are there recurring episodes of memory loss and confusion?3. Has the person tended to become more socially isolated and stay at home most ofthe time?4. Has the person become more argumentative and resistant to offers of help?5. Has the person tended to neglect personal hygiene, not been eating regularly, andnot keep appointments, especially doctor’s appointments?6. Has the individual been neglecting his or her medical treatment regimen?7. Has the individual been neglecting to manage his or her income effectively?8. Has the individual been in trouble with the law?9. Has the individual caused problems with neighbors?10. Has the individual been subject to excessive falls or accidents?11. Does the individual frequently use benzodiazepines (Valium, Librium, Xanax, etc.)?12. Has drinking been associated with any of the above situations?