Managing alcohol withdrawal in the elderly

The alcohol withdrawal syndrome is common in elderly individuals who are al cohol dependent and who decrease or stop their alcohol intake. While there have been few clinical studies to directly support or refute the hypothesis that withdrawal symptom severity, delirium and seizures increase with adva ncing age, several observational studies suggest that adverse functional an d cognitive complications during alcohol withdrawal do occur more frequentl y in elderly patients. Most elderly patients with alcohol withdrawal sympto ms should be considered for admission to an inpatient setting for supportiv e care and management, However, elderly patients with adequate social suppo rt and without significant withdrawal symptoms at presentation, comorbid il lness or past history of complicated withdrawal may be suitable for outpati ent management. Although over 100 drugs have been described for alcohol withdrawal treatmen t, there have been no studies assessing the efficacy of these drugs specifi cally in elderly patients. Studies in younger patients support benzodiazepi nes as the most efficacious therapy for reducing withdrawal symptoms and th e incidence of delirium and seizure. While short-acting benzodiazepines, su ch as oxazepam and lorazepam, may be appropriate for elderly patients given the risk for excessive sedation from long-acting benzodiazepines, they may be less effective in preventing seizures and more prone to produce discont inuation symptoms if not tapered properly. To ensure appropriate benzodiaze pine treatment, dose and frequency should be individualised with frequent m onitoring, and based on validated alcohol withdrawal severity measures. Sel ected patients who have a history of severe or complicated withdrawal sympt oms may benefit from a fixed schedule of benzodiazepine provided that medic ation is held for sedation. P-Blockers, clonidine, carbamazepine and halope ridol may be used as adjunctive agents to treat symptoms not controlled by benzodiazepines. Lastly, the age of the patient should not deter clinicians from helping the patient achieve successful alcohol treatment and rehabili tation.