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Release: Dec. 19, 2002

UI studies point to alcohol abuse treatment needs of older Iowans

Two University of Iowa investigations point to alcohol abuse problems in two groups of older Iowans: citizens age 65 and older and prison inmates age 55 and older. The two analyses, which appear in the November-December issue of the American Journal of Geriatric Psychiatry, suggest that both groups are not sufficiently diagnosed or treated for their problems.

Up to 15 percent of elder Iowans appear to be at risk for alcoholism and face special problems because they live in rural state, one analysis showed. That report was based on Iowa Department of Public Health community surveys. Stephan Arndt, Ph.D., UI professor of psychiatry, served on that study team and also co-authored the prison-based study, which revealed that 71 percent of the older inmates reported a substance abuse problem, usually alcoholism, but fewer than two in three had ever received treatment or counseling. That study examined substance abuse histories provided by nearly 11,000 offenders as part of their entry interviews into prison.

"A substantial number of older people in Iowa, as well as nationally, have alcohol abuse problems, and these often are not brought to the attention of professionals so that individuals can receive help," said Arndt, who also is director of the Iowa Consortium for Substance Abuse Research and Evaluation. "People also haven't focused on rural states to see what the special issues are in these areas. Iowa is a good place to study this issue because of its growing population of older people."

Iowa currently ranks in the top five among states with a high proportion of citizens age 65 and older. However, the state does not have many programs that are tailored to assist elderly people with a substance abuse problem, which usually is alcoholism in that age group. Excessive drinking in older people can be very stressful on the body and compromise the ability to live independently.

Arndt said that the two articles, while focused on different elder populations, together show how difficult it is to diagnose older people with substance abuse problems and get them proper care.

"The prison study indicates that older prisoners have had fewer treatment opportunities than middle-aged or younger inmates," Arndt said. "The investigation also revealed that people typically will not get substance abuse treatment while in prison, so they're coming out with the same problem they had when they came in."

Carolyn Turvey, Ph.D., UI assistant professor of psychiatry, who also was on both study teams, underscored this problem and said that one of the most striking things about the elder prison inmates was their high rate of "pure alcohol abuse with no other substance abuse problems."

"These older offenders also had low rates of ever having been treated," Turvey said. "These differences suggest that the most effective treatment of their alcoholism may differ from that of younger prisoners, who tend to have alcoholism accompanied by other substance abuse problems. The prison-based study suggests that stricter sentencing laws and substance abuse together contribute to the incarceration of older people.

Turvey said that the findings also suggest that it may be important to consider ways other than imprisonment to help these individuals who currently are going to prison late in life for alcohol-related offenses.

The tendency of older inmates to abuse only alcohol reflects the trend in the overall community, the researchers said. In the community, there is an additional hidden problem when it comes to older women.

"If an older woman goes to her physician and says she's having trouble sleeping, is losing weight and getting headaches, the physician may assume it is psychosomatic or some other type of problem and doesn't stop to ask if the patient is drinking," Arndt said.

Arndt said that drinking in the elderly can directly damage the liver, heart and stomach, in particular. It also can contribute to deadly or debilitating accidents and falls that may require the person to give up independent living.

Arndt said the next step is to examine what existing treatments target populations age 65 and older. Such information would be useful in making treatments more effective and readily available.

Susan Schultz, M.D. UI associate professor of psychiatry, was lead author on the general population study. Michael Flaum, M.D., associate professor of psychiatry, was on the study regarding prisons.

The study on the general population was supported in part by a federal Department of Health and Human Services grant and the Iowa Department of Public Health.

Visit the Iowa Consortium for Substance Abuse and Evaluation online at

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