Treatment of alcohol use disorders in the elderly: an overview of RCTs

Abstract

In this issue of International Psychogeriatrics, our research group published a paper on alcohol use disorders (AUD) in elderly adults (Kist et al., 2014). According to different authors, age of onset is an important characteristic to distinguish subgroups of patients with AUD, similar to, for example, late-onset depression (LOD) and late-onset schizophrenia (LOS). The cut off age to discriminate between early and late-onset AUD varies but is often 25 years, which is substantially younger than the cutoffs to discriminate LOD or LOS. However, in AUD, many patients started having alcohol problems much later in life, for example, after 45, 50, or even after 60 years. These very late onset patients are almost completely ignored in research. In a group of older inpatients with AUD, we found that those who started drinking heavily after 25 and after 45 years of age have similar cognitive impairments compared with their peers who started drinking before 25 years of age. Our results are counter-intuitive at first instance, but some other authors have found the same results. However, several potential limitations may also account for this result, and replication is needed before conclusions that are more definite can be drawn. In the preparation of this editorial, we found a lack of research in patients who started drinking excessive amounts of alcohol very late in life. This is in contrast with, for example, a fair amount of research in LOD and at least some research in LOS.

Safety and Persistence of Nalmefene Treatment for Alcohol Dependence. Results from Two Post-authorisation Safety Studies

“…Although elderly patients had a higher rate of ADR during follow-up (18.6% of elderly patients vs. 12.0% in the TAP), the generally favourable benefit–risk profile observed for nalmefene in this population is important because there are often certain precautions with other medications for alcohol dependence. For example, it is current practice to avoid using disulfiram in the older population due to the risk of cardiovascular side effects, medication interactions and exacerbation of underlying medical conditions ( Kuerbis and Sacco, 2013 ; Kok, 2014 ). While there is some evidence for naltrexone in the older population ( Oslin et al ., 1997 ), nalmefene may be preferred because there is no need to monitor liver function before and during treatment.…”

Substance use disorders among older adults: A review of randomized controlled pharmacotherapy trials

“…Among these interventions, naltrexone appears to be the most widely used for the treatment of alcohol use disorder and is the most studied. In contrast, disulfiram is less commonly used due to the risk of cardiovascular side effects, medication interactions, and exacerbation of underlying medical conditions or mood disorders in this population[9]. Of note, studies analyzing other pharmacological treatments such as acamprosate, disulfiram, and buprenorphine are lacking among older adults[10].…”

Abhängigkeitserkrankungen des alternden und alten Menschen

“…Die bei älteren Menschen erzielten Abstinenzraten stimmen mit den Zahlen von jüngeren Patienten überein, die Berücksichtigung von altersspezifischen Modalitäten scheint die Ansprechraten zu verbessern [31]. In Interdisziplinären Untersuchungen liessen sich nur teilweise signifikante Unterschiede zwischen Intervention und care as usual nachweisen, die Outcomevariablen (Anzahl der Drinks, riskanter Konsum, AUDIT-Score) verbesserten sich in beiden Gruppen signifikant [32]. In einer älteren Studie wirkte sich ein tolerantes, rehabilitativ ausgelegtes Programm signifikant besser auf die Patienten aus, als ein auf völlige Abstinenz und konfrontativ ausgelegter Studienarm [33].…”

“…Mit zunehmendem Alter stiegen die Abstinenzraten an. Aufgrund von Heterogenität und niedrigen qualitativen Studienstandards kann jedoch keine eindeutige Aussage zur Wertigkeit dieser Ergebnisse gemacht werden [32].…”

“…Typische Risiken, die ältere Menschen für den Gebrauch von Suchtmitteln anfällig machen, sind verstärkt auftretende Verlustereignisse, Verkleinerung des sozialen Netzwerks und finanzielle Einbussen [35]. Möglicherweise respondieren ältere Menschen sogar besser als Jüngere, denn altersspezifische Therapieansätze verbessern das Outcome im Vergleich zu altersgemischten Gruppen und jüngeren Patienten [32,36,37]. Höheres Alter und soziale Unterstützung sind in Therapiestudien mit Langzeitremissionen und Abstinenz assoziiert [38].…”