Late onset problem drinking in older adults

After the first descriptions of late onset alcoholism in the early 1970s, no systematic attention followed for more than a decade. In the past 10 years, however, that has changed, and this report seeks to summarize recently acquired knowledge about late onset problem drinking, including the author's own work on this phenomenon. The incidence of new alcoholism cases does decline with age but remains appreciable into the late sixties. Samples of ageing alcoholics in treatment show that as many as ¼ to ⅔ of cases had onset after age 60. Risk factors for late onset alcoholism include female gender, higher socioeconomic status and (in some but not all studies) life stressors, but neither psychiatric comorbidity nor positive family history of alcoholism appears to contribute in a majority of cases. Compared to longstanding alcoholics, late onset cases tend to be milder and more circumscribed, and they may also fluctuate more, with an apparently high likelihood of spontaneous remission, at least over the short term. These characteristics have implications for the use of brief and informal interventions to prevent and reduce late onset problem drinking, but also suggest caution in interpreting the response of late onset cases to treatment in uncontrolled studies. Present knowledge of late onset alcoholism is fragmentary; more systematic clinical research on its characteristics and treatment is needed.