The presentation of elderly people with alcohol use disorders may be atypical (such as falls, confusion, depression) or masked by comorbid physical or psychiatric illness, 2 which makes detection all the more difficult. 11 Among elderly people, socio-demographic factors associated with alcohol use disorders include being male, 12, 13 socially isolated, 14 single, 14, 15 and separated or divorced.
In general, however, the prevalence for elderly inpatients is higher than for elderly people in the community, with estimates of 14% for patients in emergency departments, 18% for medical inpatients, and 23-44% for psychiatric inpatients. 10 For hospital based studies, the same difficulties abound as the definitions for alcohol use disorders are not clearly specified in many studies. 7 Rates of alcohol use disorders also vary depending on the restrictiveness of diagnostic criteria used, with higher rates for “excessive alcohol consumption” and “alcohol abuse” than “alcohol dependence syndrome.” For example, community based studies have estimated the prevalence of alcohol misuse or dependence as 2-4%, 9 with much higher rates of 17% (men) and 7% (women) when looser criteria such as excessive alcohol consumption are used. Most prevalence studies have been carried out in North America, and results may not be generalisable to other cultures. For example, the drinking habits of Americans from the 1920s may differ substantially from those from the era after the second world war because of the effects of prohibition. 7 The cross sectional nature of prevalence studies also means that a cohort effect cannot be ruled out. The prevalence of alcohol use disorders in elderly people is generally accepted to be lower than in younger people, but rates may be underestimated because of underdetection and misdiagnosis, the reasons for which are many and varied.
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