The older alcoholic: recognizing the subtle clinical clues

Alcoholism is a common disease in older patients, affecting up to 10% of those living at home and as many as 40% of those in nursing homes. Symptoms tend to be nonspecific, including "failure to thrive," insomnia, diarrhea, and dementia. Morbidity and increased mortality can occur with no more than one or two drinks daily, because of altered pharmacokinetics with aging. Recognizing alcohol-induced brain injury, which can resemble Alzheimer's disease, is particularly important in the management of older patients. Withdrawal is more severe and prolonged than in younger patients and may require the judicious use of benzodiazepine therapy.