Fink A, Hays R D, Moore A A, Beck J C
Department of Medicine, University of California, Los Angeles.
Arch Intern Med. 1996 Jun 10;156(11):1150-6.
Demographic trends reveal the elderly to be the fastest growing segment of the population. Physicians can therefore anticipate encountering increasing numbers of older patients with alcohol-related problems. These problems include liver disease, dementia, confusion (masquerading as dementia), peripheral neuropathy, insomnia, late-onset seizure disorder, poor nutrition, incontinence, diarrhea, myopathy, inadequate self-care, macrocytosis, depression, fractures, and adverse reactions to medications. Despite the prevalence of alcohol use in older people, their risks and problems are often unrecognized. We reviewed published literature on the determinants and consequences of alcohol-related problems in persons aged 65 years and older and the usefulness of available screening measures. Thirteen of 25 eligible studies on determinants and consequences met quality criteria and were reviewed. Nine additional studies on screening tests were also evaluated. Determinants include history of alcohol use and abuse, social isolation, and reduced mobility; consequences consist of risks of hip fracture from falls, neoplasms, and psychiatric illness. Currently accessible screening tests focus on high levels of alcoholic beverage use and abuse and dependence. They are not useful in screening for hazardous consumption that may result from relatively low levels of alcohol use alone or in combination with medications, medical illness, or preexisting diminished physical, emotional, or social function. Research is needed on the consequences of lower levels of alcohol consumption on the physical and psychosocial health of older individuals and on methods for distinguishing alcohol-related from age-related problems. Existing screening tests should be expanded or new screening methods developed in anticipation of a growing public health problem.
人口趋势显示老年人是人口中增长最快的群体。因此，医生可以预期会遇到越来越多有酒精相关问题的老年患者。这些问题包括肝病、痴呆、意识模糊（伪装成痴呆）、周围神经病变、失眠、迟发性癫痫障碍、营养不良、失禁、腹泻、肌病、自我护理不足、大细胞性贫血、抑郁症、骨折以及药物不良反应。尽管老年人中饮酒现象普遍，但他们的风险和问题往往未被认识到。我们回顾了已发表的关于65岁及以上人群酒精相关问题的决定因素和后果以及现有筛查措施有效性的文献。25项关于决定因素和后果的符合条件的研究中有13项符合质量标准并进行了回顾。另外还评估了9项关于筛查测试的研究。决定因素包括饮酒和酗酒史、社会隔离以及行动能力下降；后果包括因跌倒导致髋部骨折、肿瘤和精神疾病的风险。目前可获得的筛查测试主要关注高酒精饮料使用、滥用和依赖情况。它们对于筛查可能仅由相对低水平饮酒或与药物、疾病或先前存在的身体、情感或社会功能减退相结合而导致的有害饮酒情况并无用处。需要对较低水平饮酒对老年人身体和心理社会健康的影响以及区分酒精相关问题和年龄相关问题的方法进行研究。鉴于这一日益严重的公共卫生问题，应扩大现有的筛查测试或开发新的筛查方法。
