Canadian Guidelines on Alcohol Use Disorder Among Older Adults

Peter R Butt; Marilyn White-Campbell; Sarah Canham; Ann Dowsett Johnston; Eunice O Indome; Bonnie Purcell; Jennifer Tung; Lisa Van Bussel

doi:10.5770/cgj.23.425

Canadian Guidelines on Alcohol Use Disorder Among Older Adults

Can Geriatr J. 2020 Mar 30;23(1):143-148. doi: 10.5770/cgj.23.425. eCollection 2020 Mar.

Authors

Peter R Butt^{1

2}, Marilyn White-Campbell³, Sarah Canham⁴, Ann Dowsett Johnston^{1

2

3

4

5

6

7

8

9}, Eunice O Indome⁵, Bonnie Purcell^{6

7}, Jennifer Tung⁸, Lisa Van Bussel^{7

9}

Affiliations

¹ Department of Family Medicine, University of Saskatchewan, Saskatoon, SK.
² Saskatchewan Health Authority.
³ Baycrest Health Sciences, North York, ON.
⁴ College of Social Work, University of Utah, Salt Lake City, UT, USA.
⁵ School of Public Health and Health Systems, University of Waterloo, Waterloo, ON.
⁶ London Health Sciences Centre, London, On.
⁷ Department of Psychology, Western University, London, ON.
⁸ Grand River Hospital, Kitchener, ON.
⁹ Parkwood Institute, London, ON.

Abstract

Background: Alcohol use disorder (AUD) is an increasingly common, under-recognized, and under-treated health concern in older adults. Its prevalence is expected to reach unprecedented levels as the Canadian population ages. In response, Health Canada commissioned the Canadian Coalition of Seniors' Mental Health to create guidelines for the prevention, screening, assessment, and treatment of AUD in older adults.

Methods: A systematic review of English language literature from 2008-2018 regarding AUD in adults was conducted. Previously published guidelines were evaluated using AGREE II, and key guidelines updated using ADAPTE method by drawing on current literature. Recommendations were created and assessed using the GRADE method.

Results: Twenty-two recommendations were created. Prevention recommendations: Best advice for older adults who choose to drink is to limit intake to well below the national Low-Risk Alcohol Drinking Guidelines. Screening recommendations: Alcohol consumption should be reviewed and discussed on an annual basis by primary care providers. This type of discussion needs to be normalized and approached in a simple, neutral, straight-forward manner. Assessment recommendations: Positive screens for AUD should be followed by a comprehensive assessment. Once more details are obtained an individualized treatment plan can be recommended, negotiated, and implemented. Treatment recommendations: AUD falls on a spectrum of mild, moderate, and severe. It can also be complicated by concurrent mental health, physical, or social issues, especially in older adults. Naltrexone and Acamprosate pharmacotherapies can be used for the treatment of AUD in older adults, as individually indicated. Psychosocial treatment and support should be offered as part of a comprehensive treatment plan.

Conclusion: These guidelines provide practical and timely clinical recommendations on the prevention, assessment, and treatment of AUD in older adults within the Canadian context.

Keywords: alcohol; alcohol dependence; alcohol use disorder; geriatric; guideline; older adult; substance abuse; substance use disorder; systematic review.