Substance abuse is a common affliction among the elderly population. Several factors may contribute to the prevalence of alcoholism and drug abuse among older adults, including loneliness, poor health, and depression. The most rapidly growing segment of the American population is the elderly, and whether or not alcohol can be considered beneficial or detrimental in this population depends on the doses being consumed (Ferreira and Weems, 2008). However, the population of older adults is increasing and so is the proportion of elderly individuals demonstrating alcohol abuse (Ferreira and Weems, 2008).
It is estimated that by 2030 the proportion of adults comprising the elderly population (65 years and older) will reach 20%, which marks double the current number (Duncan et al., 2010). Interestingly, substance abuse in general has shown increases in the elderly population, with a steady increase in primary substance abuse problems other than alcohol observed in the elderly population (Duncan et al., 2010). Alcohol abuse among elderly people, especially among men, is a public health concern that warrants attention, and it is predicted that problem drinking among elderly people will increase in future generations (Atkinson, 1990). Also, often times alcoholism among elderly people has a late onset and is not properly identified (Atkinson, 1990). This is due to lack of validation for the use of screening and diagnostic methods with the elderly population (Atkinson, 1990). Substance abuse and dependence is a problem across all age categories, but there are key similarities and differences in problem drinking behavior between younger and older adults, and substance abuse in young adulthood may be a risk factor for alcoholism later in life. The following investigation explores how much alcoholism in young adulthood affects alcohol abuse in the elderly.
There are important differences in early-onset and late-onset alcoholism. Shahpesandy et al. (2006) hypothesized that alcoholism in these two age cohorts could be differentiated by substance related issues that could be classified as more severe, a more frequent family history of alcohol abuse, a higher rate of mortality, as well as increased antisocial behavior. These researchers compared results of the Geriatric Scale of Depression, the Standardized Mini-Mental State Examination and the Munich Alkoholism Test between groups of young alcoholics, elderly alcoholics, and elderly non-alcoholics (Shahpesandy et al., 2006).
Results of the study indicated that family history was more associated with alcoholism in younger adults than in older adults. Education level and marital status were found to be significantly different between young alcoholics and elderly alcoholics. It was found that significantly more elderly alcoholics were married compared with young alcoholics, and elderly alcoholics had significantly less education than young alcoholics (Shahpesandy et al., 2006). Abstinence level differed between the two groups as well, with the elderly alcoholic group abstaining more frequently than young alcoholics (Shahpesandy et al., 2006). Overall, the young alcoholic group was found to have significantly more family history of alcoholism, drink larger amounts of alcohol, have a greater forensic history, and more personality disorders in comparison with elderly alcoholics (Shahpesandy et al., 2006). Conversely, the elderly alcoholic group was exhibited more somatic complications as a result of alcohol abuse, drink less and abstain from drinking more, and demonstrated significantly less psychopathic traits (Shahpesandy et al., 2006). Also, elderly alcoholics were significantly more likely to be married, have less aducation, and belong to a lower social class than younger alcoholics (Shahpesandy et al., 2006).
An important question to postulate involves the level of alcohol consumption that can be considered as hazardous for elderly people. Lang et al. (2007) sought to examine risks involving disability and mortality as they relate to the level of alcohol consumtion among the elderly. These researchers conducted their investigation through two cohort studies that were population based, and the participants were 13,333 elderly individuals that were followed in the study for between 4 to 5 years. The results indicated that a substantial amount of men and women and men in the U.S. And England drank more alcohol than the recommended levels put forth by the U.S. National Institute on Alcohol Abuse and Alcoholism for individuals over the age of 65 years (Lang et al., 2007). The study also determined a significant relationship between increased alcohol consumption and increased risk of disability for elderly men and women in the study (Lang et al., 2007). However, overall the mortality and functioning outcomes in elderly people that consume alcohol at higher than recommended levels were found to not be poor (Lang et al., 2007).
What effect does moderate alcohol consumption have on the cognitive functioning of older individuals? This question was investigated by McGuire et al. (2007) who examined the association between moderate alcohol drinking and cognitive functioning and differences between sexes in the elderly over the course of four years. The researchers used multiple logistic regression models in order to predict cognitive functioning according to alcohol consumption (McGuire et al., 2007). Results of the study indicated that there were significant differences in the relation between alcohol consumption and cognitive functioning in the elderly (McGuire et al., 2007). Furthermore, alcohol consumption of one drink per day or less compared with abstinence was associated with lower odds of low cognitive functioning in women but not in men (McGuire et al., 2007). This indicated that for elderly people with normal cognitive functioning, moderate alcohol consumption had a protective effect on cognitive functioning for women but not for men (McGuire et al., 2007). This demonstrates that there is a level of alcohol consumption that may be considered acceptable or even protective for elderly individuals. However, consumption beyond moderate levels may result in alcoholism, which has detrimental physical, mental, and social effects.
Consumption of alcohol beyond moderate levels in the elderly can have greater effects in the elderly and may have adverse cognitive effects (Peters et al., 2008). Some studies have indicated that moderate alcohol consumption is associated with decreased risk of cognitive decline and dementia in the elderly, as well as decreased cardiovascular risk due to antioxidant properties in alcohol (Peters et al., 2008). However, excessive alcohol consumption among the elderly is related to significant decreases in memory function (Peters et al., 2008).
Peters et al. (2008) looked at ten years of published research literature and determined that low to moderate alcohol use was associated with a risk reduction of 38% for dementia. However, it is difficult to establish causality in this association. The above researchers suggested that the protective effects could have been over-estimated due to a lack of standardization in studies (Peters et al., 2008). Causality of protective effects may be due to the fact that individuals that drink moderately are able to moderate other aspects of their lives in regard to mental, dietary, and physical factors (Peters et al., 2008). Causality will continue to be difficult in regards to determining effects of alcohol consumption because conducting randomized placebo controlled trials are not ethically possible (Peters et al., 2008).
There is a key difference between moderate alcohol consumption and alcohol abuse. Alcohol abuse among the elderly often results in neurodegeneration, while moderate drinking has been found to have cardiological benefits, including a reduction in cerebral vascular burden and peripheral vascular pathology, as well as decreased atrophy of the hippocampus and amygdala (Chiu, 2008). Chiu (2008) recognized that there are several confounding variables that influence the perceived effect that alcohol consumption has on elderly people. These confounding variables include obesity, heavy smoking history, diabetes, and vascular diseases, and they make the interpretation of research results difficult (Chiu, 2008). The only way to successfully determine the effects of alcohol consumption on the elderly is to utilize methodology that is both stringent and vigorous (Chiu, 2008). Furthermore, it is suggested by other researchers that alcohol abuse disorders among the elderly are often ignored and hidden by scholars and clinicians (Atkinson, 1990).
Moreover, alcoholism characterized by alcohol abuse and dependence among the elderly population is a growing social and public health concern (Liberto et al., 1992). Research has consistently demonstrated that the frequency and quantity of alcohol consumption, as well as the amount of problems considered to be related to alcohol, are significantly higher among elderly men than among elderly women (Liberto et al., 1992). Interestingly, a study conducted by Liberto et al. (1992) determined that elderly individuals with lower incomes tended to consume less alcohol than elderly individuals with higher incomes, and that one-third to one-half of elderly individuals with alcohol abuse problems experienced the onset of alcoholism in middle life or later in life. Furthermore, treatments for elderly alcoholics that had late-onset problem drinking appeared to have better outcomes than alcoholics with earlier onset problem drinking (Liberto et al., 1992).
It is important that appropriate diagnostic criteria and instruments be researched and utilized to properly assess alcohol abuse among the elderly. There are key differences between alcoholics with a late onset in life compared with earlier onset alcoholics. Wetterling et al. (2003) aimed to determine exactly what these key differences were. The study indicated significant differences in alcohol dependence between early onset and late…