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Objective: To determine the prevalence, geographic variation, and charges to Medicare of alcohol-related hospitalizations among elderly people in the United States.Design: A cross-sectional prevalence study using 1989 hospital claims data from the Health Care Financing Administration (HCFA). Rates were determined using (1) hospital claims records from the HCFA's Medicare Provider Analysis and Review Record (MEDPAR) database for all Medicare Part A beneficiaries aged 65 years and older; (2) county population estimates for 1985 from the Bureau of the Census; and (3) per capita consumption of alcohol by state in 1989 as estimated by the US Department of Health and Human Services.Setting: Data include all hospital inpatient Medicare Part A beneficiaries aged 65 years and older in the United States in 1989.Results: The prevalence of alcohol-related hospitalizations among people aged 65 years and older nationally in 1989 was 54.7 per 10,000 population for men and 14.8 per 10,000 for women. Comparison with hospital records showed that MEDPAR data had a sensitivity of 77% to detect alcohol-related hospitalizations. There was considerable geographic variation; prevalence ranged from 18.9 per 10,000 in Arkansas to 77.0 per 10,000 in Alaska. A strong correlation existed between alcohol-related hospitalizations and per capita consumption of alcohol by state (Spearman correlation coefficient, .64; P < .0001). In 1989, the hospital-associated charges to Medicare for all admissions where the primary diagnosis was alcohol related (N = 33,039) totaled $233,543,500. Median charge per hospital stay was $4514.Conclusions: Alcohol-related hospitalizations among elderly people are common; rates were similar to those for myocardial infarction as detected by the same method. The charges to Medicare for this preventable problem are considerable. Ecological analysis suggests that per capita consumption in the total US population predicts alcohol-related hospitalizations in the elderly population. [ABSTRACT FROM AUTHOR]

Injuries are a common cause of morbidity and mortality among elderly people. Falls are the most common type of accident, accounting for around 40% of injuries. There is substantial evidence that heavy alcohol use is an important risk factor for injuries in younger people, but results of the few studies of alcohol and injuries among elderly people have been inconsistent. In this paper, we review the literature on the effects of alcohol on gait and balance and present reasons that a causal relationship between alcohol and injuries is biologically plausible. We review the epidemiological studies of the relationship between alcohol and falls, hip fractures and other injuries in the elderly population and discuss sources of error in these studies. Selection bias, small sample sizes, measurement error and potential confounders such as age, gender, health status and medications may have played a substantial role in negative results from several studies. Further research that will help clarify the relationship between alcohol and injuries in elderly people is sorely needed. [ABSTRACT FROM AUTHOR]

Alcohol drinking, alcohol abuse, and alcoholism are more common among men than women at all ages. This article reviews the epidemiology and clinical effects of alcohol use in aging men. Alcoholism demands aggressive intervention when encountered in cognitively impaired people.

Objectives: To describe potentially hazardous alcohol use among elderly patients in the primary care setting and to assess the widely used CAGE questionnaire (cut down, annoyed by criticism, guilty about drinking, eye-opener drinks) as a tool for detecting self-reported heavy and binge drinking among these patients., Design: Cross-sectional study., Setting: The offices of 88 primary care physicians at 21 sites in southeastern Wisconsin., Patients: A total of 5065 consecutive consenting patients older than 60 years., Measures: A previously validated self-administered questionnaire that included beverage-specific questions about the quantity and frequency of regular drinking in the last 3 months, the number of episodes of binge drinking (> or = 6 drinks per occasion), and the CAGE questionnaire., Results: Fifteen percent of men and 12% of women regularly drank in excess of limits recommended by the National Institute of Alcohol Abuse and Alcoholism (>7 drinks per week for women and >14 drinks per week for men). Nine percent of men and 2% of women reported regularly consuming more than 21 drinks per week. When we administered the CAGE questionnaire, 9% of men and 3% of women screened positive for alcohol abuse within 3 months. The CAGE performed poorly in detecting heavy or binge drinkers; fewer than half were CAGE positive when the standard cutoff of 2 positive answers was used., Conclusions: Alcohol consumption in excess of recommended limits is common among elderly outpatients. The CAGE questionnaire alone is insufficient to detect such drinking. Asking questions on the quantity and frequency of drinking in addition to administering the CAGE increases the number of problem drinkers detected.

Objectives: Anecdotal reports and two previous studies suggest that retirement communities have a particularly high prevalence of heavy drinking. The objective of this study was to verify or refute this finding and to identify characteristics associated with heavy drinking in retirement communities., Methods: This cross-sectional study used a mailed survey to gather information from three retirement communities in suburban Milwaukee, Wisconsin. The questionnaire included alcohol use questions adapted from the Khavari questionnaire and the CAGE questionnaire to screen for alcohol abuse., Results: Three hundred seventeen of 454 independent residents of the retirement communities completed and returned surveys for a response rate of 70%. Mean age of respondents was 83 +/- 6 years, 100% were white, 77% were female. Forty-seven percent used some alcohol, 15% had one to six drinks per week, 8% had seven or more drinks per week. Only two people screened positive on the CAGE questionnaire for abusive drinking. The majority of drinkers had decreased alcohol use since moving to the community. Male sex, socialization, lack of religious affiliation, and smoking were factors whose percentages increased significantly with increasing alcohol use. Although drinkers were more likely to smoke cigarettes, no indicators suggested that they were less healthy than abstainers., Conclusions: Despite the advanced age of this population, regular alcohol use was prevalent. In contrast to previous reports from retirement communities, heavy and abusive drinking were uncommon by our measures, perhaps because of the older age and female predominance of the sample. Drinking appears to be associated with more social contacts and, possibly, better health status.

The prevalence of alcohol use and misuse declines with age, but misuse remains an important public health problem among older people. Between 2 and 4% of the United States elderly population meet DSM-III criteria for "alcohol abuse" or dependence. Up to 10% are "heavy" or problem drinkers. Alcohol use and misuse are both more common among men than women. Since the elderly population is expanding, we will see an increase in the absolute number of older problem drinkers over the next few decades even if the prevalence of problem drinking remains constant. It is incumbent on health care providers and administrators to plan for the prevention and treatment of alcohol problems among these people.

More than 75% of people age 65 and older use medications. Of the drugs most commonly used by older people, many have potential to interact adversely with alcohol. The absorption, distribution, metabolism, and effects of drugs or alcohol may be affected. The major adverse clinical outcomes of drug-alcohol interactions are altered blood levels of the medication or of alcohol, liver toxicity, gastrointestinal inflammation and bleeding, sedation and delirium, disulfiram-like reactions, and interference with the desired effect of medications. Since alcohol is commonly used by elderly people, educating patients about the potential for these interactions should be a routine part of health care visits.

Objectives: Medications and alcohol are both used commonly by older people. Thus, the potential for adverse drug-alcohol interactions is very high in this population, but data on actual concurrent use of alcohol and medicines likely to interact with alcohol are lacking. The objectives of this study were to determine the frequency of alcohol and medication use and the potential for specific adverse drug-alcohol interactions in residents of retirement communities., Design: Cross-sectional study using a mailed survey., Setting: Three retirement communities in suburban Milwaukee, Wisconsin., Participants: All 454 independently living residents of the communities were surveyed. Of these, 311 residents (68%) returned completed questionnaires. Mean age of respondents was 83 +/- 6 years, 100% were white, 77% were female., Measurements: The questionnaire included alcohol use questions adapted from the Khavari questionnaire and the CAGE questionnaire to screen for alcohol abuse. Respondents were asked to list all prescription and nonprescription medications., Results: Thirty-eight percent of the population reported using both alcohol and a high risk medication. Six percent had seven or more drinks per week and took a high risk medication. High risk drugs commonly used by drinkers were antihypertensives in 50%, aspirin in 27%, nonsteroidal anti-inflammatory drugs in 20%, medication for congestive heart failure in 18%, antacids or H2 blockers in 16%, sedatives in 11%, narcotics in 5%, and warfarin in 5%., Conclusions: Concurrent use of alcohol and medications is common in residents of these retirement communities. Many of the drugs taken by regular drinkers have potential for adverse drug-alcohol interactions even at moderate levels of alcohol use. This represents a strong possibility of adverse outcomes and a need for increased awareness on the part of both the public and physicians of the potential for interactions between drugs and alcohol.

Objectives: To determine the prevalence of alcohol abuse in elderly emergency department (ED) patients; to determine the prevalence of alcohol abuse for various categories of illness and injury among these patients; and to determine the frequency of detection of elderly alcohol abusers by ED physicians., Design: Cross-sectional prevalence study., Setting: The emergency department of a 625-bed university hospital that serves a mixed urban and rural population., Patients: 205 patients aged 65 and over who came to the ED during an 8-week period., Measures: A structured interview, which included the CAGE questionnaire and other questions regarding alcohol use, was administered. Emergency department records and past medical records were reviewed., Results: The prevalence of lifetime alcohol abuse (CAGE positive or self-reported drinking problem) was 24%. The prevalence of current alcohol abuse (CAGE positive or self-reported drinking problem and alcohol use within the last year) was 14%. There was a particularly high prevalence (22%) among those presenting with gastrointestinal problems and a surprisingly low prevalence (7%) among those who presented with falls or other trauma. Physicians detected only 21% of the current alcohol abusers., Conclusions: Alcohol abuse is a prevalent and important problem among elderly ED patients. It is not well detected by physicians in this setting. Alcohol abuse appears to be less common among elderly trauma patients than their younger counterparts, but is very common among patients with gastrointestinal problems.

Several cross-sectional studies have shown a decline in alcohol intake with increasing age. Longitudinal studies have failed to confirm this trend, which suggests that cohort effects may account for the reported decline. To address this, both cross-sectional and longitudinal analyses of alcohol use in 270 healthy elderly persons over a seven-year period (1980-1987) were performed. Alcohol consumption was assessed by three-day diet records. One hundred sixty-five subjects (61.1%) remained in the study until 1987; 143 (53%) completed diet records for every year. Longitudinal analysis showed a statistically significant decline in the percent of subjects consuming any alcohol over time (slope = -2% per year; 95% confidence interval -2.8, -1.1%). A cross-sectional analysis of the 1980 data revealed a similar decline in percent drinkers with increasing age (slope = -2.7% per year; 95% confidence interval -4.4, -1.1%). Mean alcohol intake for those who continued to drink did not change over time except among heavy drinkers (consumption of greater than 30 g per day in 1980), who did show a significant decline in mean alcohol intake (P = .02). Thus, in our population the decline in percent of drinkers with age found by a cross-sectional analysis was confirmed in longitudinal analyses, suggesting that this represents a true age-related decline rather than a cohort effect.

A safe effective method of global control during anterior segment surgery is presented. The method used in 1184 consecutive cases was the scleral yoke traction suture adapted from a method often used in strabismus surgery. The incidence of postoperative ptosis severe enough to require surgical correction is presented in that group as well as in a group of 591 consecutive cataract extractions utilizing the classic superior rectus traction surgery. The principle advantages of this method as compared to the classic superior rectus traction suture are pointed out, with emphasis on the reduction of postoperative ptosis.

The California compensation laws and labor codes make adjudication of industrial coronary disease, for purposes of determining industrial liability, difficult for the attending physician. From medical writings on the subject in the past decade and from personal experience before the Industrial Accident Commission the author draws suggestions for a sounder approach on a physiological and pathological basis. Criteria for use in determining such liability in cases of coronary heart disease due to employment are outlined.