Background: The alcohol withdrawal syndrome (AWS) poses a special threat to older adults, given the higher prevalence of comorbid medical and neurological conditions among the elderly. With a view to establishing guidelines for the identification and management of AWS, we review the literature on AWS in the elderly.
Method: A literature search was performed looking for research articles reporting on the detection, monitoring and pharmacological management of AWS in older adults. We focused on finding prospective, controlled trials and well-designed cross-sectional studies.
Results: There are conflicting reports about the association between age and severity of AWS, although it appears that older adults suffer more cognitive and functional impairment than do younger adults. Numerous studies describe the geriatric use of the CAGE questionnaire, the geriatric version of the Michigan Alcohol Screening Test and other brief screening instruments, but these usually do not pertain directly to the detection of AWS. Data from younger cohorts suggest that the Alcohol Use Disorder Identification Test (AUDIT), may be predictive of AWS severity. No instruments to monitor the course of AWS have been assessed in geriatric settings, though the Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar) has been used extensively in other settings. Finally, there have been no controlled trials of benzodiazepines or other agents in older adults with AWS.
Conclusions: Clinicians must maintain a high index of suspicion for AWS, especially when an older adult presents with delirium. Screening with the AUDIT may complement a thorough history and physical in estimating the risk of AWS. Patients with AWS should be monitored in a supervised, medically-oriented setting. Symptom-triggered administration of benzodiazepines, in conjunction with use of a standardized scale such as the CIWA-Ar, appears to the most favorable risk-benefit profile. Prospective studies are needed in the detection, monitoring and treatment of AWS.
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