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

18. Alcoholism and Substance Abuse in Older Adults 407part of an alcohol screening effort. Information from relatives, friends neighbors,and home attendants, if possible, should be obtained. A staff memberinvolved in an aging- specific treatment program should see the patient in thehospital and have the patient referred to him- or herself at the treatment site.A particularly egregious situation exists for alcoholic patients in some generalhospitals, particularly patients admitted to the surgical services. Undiagnosedalcoholic elderly patients admitted with an acute surgical emergency, suchas a hip fracture, are operated on promptly, and on the first postoperative day maydevelop acute alcohol withdrawal that produces serious morbidity and, in somecases, death. I have observed such instances frequently. There are no data todetermine how frequent such a complication occurs, but it is a preventable one!Part of every evaluation for emergency surgical and medical admissions ofthe elderly should be screening for alcoholism, as indicated, not simply askingwhether the patient drinks alcohol. If there is a suspicion of an alcohol problemuse of a benzodiazepine taper on admission or postoperatively should be instituted.The problem of using benzodiazepines in surgical patients is complicatedby a lingering belief among some physicians that ethanol, including intravenousethanol, should be used to treat or prevent alcohol withdrawal. A recentstudy documents this inappropriate use of ethanol, which can be particularlydangerous in elderly alcoholics (Rosenbaum & McCanty, 2002).The low index of suspicion of alcohol problems in the elderly and the useof ethanol for detoxification represent a problem in diagnosis and treatment,with potentially serious consequences. The need to educate the medical communityabout the diagnosis and treatment of elderly alcoholics is important,since diagnostic clues exist and effective treatment is possible.CONCLUSIONAlcoholism and prescription drug abuse in the elderly are common problems.They often are not diagnosed or treated. This chapter presents tools that can behelpful in the diagnosis of alcoholism in the elderly and suggests psychosocialtreatment based on an aging-specific approach as being most effective. Pharmacologicaltreatments, including benzodiazepines for detoxification, antidepressantsfor coexisting depression, disulfiram as a deterrent, and the anticravingdrugs naltrexone and acamprosate, were presented.The general hospital can be a place to identify, to provide detoxification,and to engage elderly patients in a friendly way. The morbidity and mortality ofalcohol withdrawal syndrome in patients admitted for medical and surgicalemergencies can be prevented if the alcohol screening is done early and benzodiazepinedetoxification is carried out soon after admission in patients likey togo into withdrawal.