Late-Life Drinking Behavior: The Influence of Personal Characteristics, Life Context, and Treatment.

The Influence of Personal Characteristics, Life Context, and Treatment Alcohol-related problems affect increasing numbers of older adults. Recent studies have begun to investigate problem drinking among older adults based on a conceptual model proposing correlations between personal characteristics, life context (i.e., environmental factors), treatment, and drinking-related outcomes. In a community sample of older problem and nonproblem drinkers, alcohol consumption, life stressors, social resources, and coping responses differed between the two groups, although these factors did not directly and uniformly affect late-life drinking behavior. Furthermore, drinking behavior did not always have the expected effects on older drinkers' life contexts. Findings from a sample of treated alcohol and other drugabusing older patients demonstrated the importance of providing mental health aftercare for this group. KEY WORDS: elderly; problematic AOD use; demographic characteristics; environmental factors; life event; treatment; psychological stress; social support; comorbidity; coping skills; AOD consumption; AODU development; predictive factor; health care utilization; longitudinal study; scientific model Historically, most efforts to understand and treat problem drinking' have focused on young and middle-aged adults. However, two factors have prompted increased attention to the alcohol-related problems of older adults.2 First, clinicians show a growing concern over the prevalence of these problems among their older patients. Second, researchers anticipate increasing prevalence of late-life problem drinking because of the currently large number of middle-aged adults and their present levels of alcohol use (Adams and Cox 1995; Beresford 1995). This heightened interest in the alcohol-related problems of older adults has inspired studies yielding considerable information about the scope and correlates of alcohol consumption and problem drinking in late adulthood. The current prevalence of alcohol abuse and dependence in the general population of older adults is between 2 and 4 percent; it is considerably higher-5 to 30 percent-in clinical populations (American Medical Association [AMA] Council on Scientific Affairs 1996; Adams and Cox 1995). Most studies have found that older adults consume less alcohol and have fewer drinking problems than do younger adults. Research has repeatedly shown that alcohol consumption and drinking problems are greater in older men than in older women. The literature also shows that latelife problem drinking is associated with a host of cognitive and health problems as well as with an increased risk of adverse medication-alcohol interactions (for reviews, see Adams 1995; AMA Council on Scientific Affairs 1996; Bucholz et al. 1995; Smith 1995; Tartar 1995). Recent research highlights the importance of distinguishing between two groups of older problem drinkers: late onset and early onset. Late onset problem drinkers, of whom a significant proportion are women, first develop drinking problems later in life (i.e., after age 50). Early onset problem drinkers, in contrast, develop drinking problems earlier during adolescence or adulthood and maintain them into late life. Compared with early onset problem drinkers, late onset problem drinkers generally are in better health (e.g., have fewer physical symptoms and experience less depression), have better social relations (e.g., are more likely to be married and less likely to be incarcerated), and are less likely to have been treated for alcohol and other drug (AOD) abuse (for reviews, see Atkinson 1995; Liberto and Oslin 1995; Schonfeld and Dupree 1991). Late onset problem drinkers, who constitute one-third to one-half of older problem drinkers, also may have a better prognosis, possibly because interventions are more effective before severe alcohol problems have robbed the drinkers of their physical and social resources (Liberto and Oslin 1995). …