Characteristics, Diagnosis, and Treatment of Alcoholism in Elderly Patients

The purpose of this study is to examine the ability of physicians to diagnose alcoholism in the elderly patient and to define characteristics specific to the elderly patient with alcoholism. During a 3-month period, all new admissions to the medical service of The Johns Hopkins Hospital were screened for alcoholism with two screening tests (the CAGE questionnaire and Short Michigan Alcohol Screening Test). The prevalence of screen-positive alcoholism was 27% in patients under 60 years of age and 21% in patients 60 years and older. Elderly patients with alcoholism were more likely to be black (P less than .01), but did not differ significantly in any other way from elderly patients who did not have alcoholism. Although 60% of screen-positive young patients with alcoholism were identified by their houseofficers, only 37% of elderly patients with screen-positive alcoholism were so identified (P less than .05). The elderly patients with alcoholism were significantly less likely to be diagnosed by their houseofficer if they were white, female, or had completed high school (P less than .01). Even when diagnosed, elderly patients with alcoholism were less likely than younger patients with alcoholism to have treatment recommended by their houseofficers (P less than .05) and, if treatment were recommended, it was less likely to be initiated (P less than .05). These data suggest that current medical education is deficient in providing physicians with the skills to detect and treat elderly patients with alcoholism.