Knowing risk factors can help identify elderly alcoholics for treatment

June 27, 2003

Less than half of alcoholics over 65 are diagnosed, a Penn State study has shown, because often the telltale signs of alcohol dependence are masked by patient denial and seeming good health .

Kristine E. Pringle, doctoral candidate in health policy and administration, and Dr. Dennis Shea, professor of health policy and administration, conducted the study.

Pringle says, "Using the risk factors we've identified in our study, health care providers and policy makers may be better able to target screenings and policy interventions toward the highest-risk groups who may be systematically under-diagnosed and under-treated."

She presented the findings in a paper, "Triangulation in Action: Prevalence and Risk Factors for Alcoholism Among Elderly Medicare Beneficiaries," at the AcademyHealth annual meeting in Nashville, Tenn., Friday, June 27. Her co-author is Shea, who is her dissertation adviser.

Pringle used data from the Medicare Current Beneficiary Survey (MCBS) and the Health and Retirement Study (HRS) which each included more than 10,000 participants. No similar research has been done using these two data sets, which enabled the Penn State researchers to examine variations in alcoholism for both diagnosed and self-reporting elderly individuals.

The researchers found a substantial disparity between the prevalence of diagnosed versus self-reported alcoholism (1.9 percent versus 4.3 percent respectively). They also found significant differences by age, gender, race, ethnicity, income, education, marital status, depression, health status, ability to drive, region, rural/urban residence, household composition and religiosity.

For example, those in excellent, very good or good health are significantly more likely to have self-reported and diagnosed alcoholism than elderly in fair or poor health.

Elderly males were significantly more likely to self-report alcoholism than elderly females but only slightly more likely to be diagnosed. Pringle says, "Older men are at particularly high risk for not being diagnosed but our results also support the view that older females may be denying a drinking problem since women are half as likely as men to self-report but only slightly less likely to be diagnosed."

"Denial may be especially problematic for other groups, including those with incomes greater than 200 percent of poverty and those aged 75 and older," she adds. "In each of these groups, the diagnosed rate is higher than the self-reported rate."

Shea notes, "The number of alcoholic elderly can be expected to increase due to the sheer number of baby boomers entering old age. To compound the problem, this generation has higher rates of substance abuse than any previous generation. The costs of alcoholism and its consequences in the elderly have the potential to create an enormous financial burden for the Medicare program. It's imperative that both health care providers and policy makers understand which elder groups are at risk and may be under-diagnosed and therefore prime screening targets."
The study was supported by the Penn State program, Interdisciplinary Training in Gerontology, which is funded by the National Institute on Aging.

Penn State

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