Elderly adults are greater consumers of prescription and 'over the counter' medications than any other age group and polypharmacy, including the co-use of alcohol, is common in this group. Age related physiological changes which influence drug concentrations, metabolism, polypharmacy and interaction of other drugs with alcohol can negatively influence functional capacity, psychomotor ability, and cognition, including attention and memory, placing the older person at greater risk of accident, injury, isolation and ultimately institutionalisation. It is argued that DSM-IV criteria used to define "abuse" or "dependence" are of limited value to the majority of elderly 'problem' alcohol or drug users, with ICD-10 criteria that identify those who are experiencing 'a risk' of or where use "is actually" causing "early" harm, more appropriate. Impediments to psychiatrists and other medical practitioners identifying 'problem' alcohol and other drug use, and appropriate assessment and intervention procedures are briefly discussed. The potential for decreasing the incidence and severity of physical and psycho/social events following a reduction or cessation in problem alcohol or other drug use means that assessment and intervention should be one cornerstone of management practice for this often disenfranchised and vulnerable group.
Ethanol; Alcoholismo; Smoking; Hipnotics and sedatives; Drug dependence; Drug abuse; Aged; Therapeutics; Case management