노년기 알코올 및 기타 물질관련장애 = Geriatric Alcohol and Other Substance-Related Disorders

국문 초록 (Abstract)

알코올, 처방약물 등 노인에서 물질남용이나 물질의존은 우리도 모르게 급증하고 있다. 노인은 특히 알코올의 부작용에 취약하다. 노인에서 물질남용이나 물질의존의 주요 결과는 정신과적 및 내과적 문제들이다. 수면장애와 자살율의 증가를 동반한 우울증 외에도, 알코올은 치매의 원인이 되거나 치매에 영향을 미칠 수 있다. 노인에서 알코올리즘의 임상양상은 젊은이에서와 다르므로 진단을 어렵게 만든다. 따라서 CAGE(Cut down, Annoyed, Guilty, Eye-opener) 설문지, AUDIT(Alcohol Use Disorders Identification Test), MASTG (Michigan Alcoholism Screening Test-Geriatric Version), SMAST-G(Short Michigan Alcoholism Screening Test-Geriatric Version) 등의 타당도 높은 산별도구들이 진단에 도움이 될 수 있다. 치료 목표는 단주이지만, 고위험군의 환자들에 대해서는 단기적 중재가 권고되며, 부작용에 조심하면서 약물치료를 사용할 수 있다.

다국어 초록 (Multilingual Abstract)

Substance abuse among older adults, including alcohol, prescription and over-the-counter drugs, has been an invisible epidemic. Elderly people are particularly vulnerable to the adverse effects of alcohol. Psychiatric and medical problems constitute major consequences of substance abuse or dependence. In addition to depression with increased risk of suicide and sleep disorders, alcohol may cause or contribute to dementia. Clinical features vary from those in younger persons, which can complicate diagnosis. Therefore, validated screening tools such as the CAGE(Cut down, Annoyed, Guilty, Eye-opener) Questionnaire, AUDIT(Alcohol Use Disorders Identification Test), MAST-G(Michigan Alcoholism Screening Test-Geriatric Version), SMAST-G(Short Michigan Alcoholism Screening Test-Geriatric Version) can aid diagnosis. Treatment goal is almost always abstinence, brief interventions are recommended for at-risk patients, pharmacotherapy may be used with caution of side effects.

목차 (Table of Contents)

• 서론
• 역학
• 진단
• 치료
• 증례
• 요약
• 참고문헌

참고문헌 (Reference)

• 1 전진숙, "한국에서 노인용 미시간주정의존선별검사의 적용을 위한 예비연구" 6 : 102-110, 1999
• 2 장환일, "한국에서 Michigan 주정의존 선별검사의 적용에 대한 예비조사" 46-53,
• 3 Rockwood K, "What shall we tell older people about alcohol?" 43 : 934-938, 2003
• 4 Hirata ES, "Validity of the Michigan Alcoholism Screening Test for the detection of alcohol-related problems among male geriatric outpatients" 9 : 30-34, 2001
• 5 Jacobson SA, "Treatment of substance-related disorders. In: Handbook of Geriatric Psychopharmacology" Washington DC: American Psychiatric Association 315-342, 2002
• 6 Blow FC, "The spectrum of alcohol interventions for older adults." Public Health Service, National Institute of Health 1998
• 7 Nasreddine ZS, "The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment" 53 : 695-699, 2005
• 8 Grant BF, "The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991-1992 and 2001-2002" 74 : 223-234, 2004
• 9 Prigerson HG, "Suicidal ideation and suicide attempts in homeless mentally ill persons" 38 : 213-219, 2003
• 10 Bartels SJ, "Suicidal and death ideation in older primary care patients with depression, anxiety, and at-risk alcohol use" 10 : 417-427, 2002
• 11 Widlitz M, "Substance abuse in older adults: an overview" 57 : 29-34, 2002
• 12 Buchsbaum DG, "Screening for drinking disorders in the elderly using the CAGE questionnaire" sch (sch): 662-7, jamgeriatrsoc1992
• 13 Lieber CS, "Relationships between nutrition, alcohol use, and liver disease" 27 : 220-231, 2003
• 14 American Psychiatric Association, "Quick Reference to the Diagnostic Criteria from Washington DC" American Psychiatric Association 105-151, 2000
• 15 Sajatovic M, "Psychiatric comorbidity in older adults with bipolar disorder" 21 : 582-587, 2006
• 16 Spar JE, "Other common mental disorders of the elderly. In: Clinical Manual of Geriatric Psychiatry" Washington DC: American Psychiatric Association 313-346, 2006
• 17 Blow FC, "Older patients with at-risk and problem drinking patterns: New developments in brief interventions" 13 : 115-123, 2000
• 18 Dupree LW, "Older alcohol abusers: recurring treatment issues" Public Health Service, National Institute of Health 339-358, 1998
• 19 Prigerson HG, "Older adult patients with both psychiatric and substance abuse disorders: prevalence and health service use" 72 : 1-19, 2001
• 20 Arndt S, "Oldeer admissions to substance abuse treatment in 2001" 13 : 385-392, 2005
• 21 Edgell RC, "Nonalcohol-related use disorders in geropsychiatric patients" 13 : 33-37, 2000
• 22 Schultz SK, "Locations of facilities with special programs for older substance abuse clients in the US" 18 : 839-843, 2002
• 23 Oslin DW, "Late-life alcoholism: issues relevant to the geriatric psychiatrist" 12 : 571-583, 2004
• 24 Letizia M, "Identifying and managing acute alcohol withdrawal in the elderly" 26 : 176-183, 2005
• 25 Weintraub E, "Geriatric patients on a substance abuse consultation service" 10 : 337-342, 2002
• 26 Knauer C, "Geriatric alcohol abuse: a national epidemic" 24 : 152-154, 2003
• 27 Aldrich MS, "Effects of alcohol on sleep" Public Health Service, National Institute of Health 281-300, 1998
• 28 Ewing JA, "Detecting alcoholism. The CAGE questionnaire." jammedass19841905-7
• 29 Atkinson R, "Depression, alcoholism and ageing: a brief review" 14 : 905-910, 1999
• 30 Fisman M, "Dementia in the elderly male alcoholic-a retrospective clinicopathological study" 209-218, 1996
• 31 Aira M, "Community prevalence of alcohol use and concomitant use of medication-a source of possible risk in the elderly aged 75 and older?" 20 : 680-685, 2005
• 32 Rivers E, "Cocaine use in elder patients presenting to an inner-city emergency department" 1 : 874-877, 2004
• 33 Blow FC, "Brief screening for alcohol problems in elderly population using the Short Michigan Alcoholiam Screening Test-Geriatric Version (SMAST-G)" 22 : 131A-, 1998
• 34 Knight RG, "Assessment of cognition and drinking practices. In: Clinical Neuropsychology of Alcoholism" Hove: Lawrence Erlbaum Associates 67-106, 1994
• 35 Sullivan J, "Assessment of alcohol withdrawal the revised clinical institute withdrawal assessment for alcohol scale" CIWA-Ar 1353-7, brjaddict1980
• 36 Carlat DJ, "Assessing alcohol dependence and drug abuse. In: The Psychiatric Interview, A Practical Guide. 2nd ed" Philadelphia: Lippincott Williams & Wilkins 181-189, 2005
• 37 Reid C, "Are commonly ordered lab tests useful screens for alcohol disorders in older male veterans receiving primary care?" 44 : 122-, 2004
• 38 Oslin DW, "Alcoholism treatment adherence: Older age predicts better adherence and drinking outcomes" 10 : 740-747, 2002
• 39 Kim JM, "Alcoholism in older Korean Men: prevalence, aetiology, and comorbidity with cognitive impairment and dementia in urban and rural communities" 17 : 821-827, 2002
• 40 Beresford TP, "Alcoholic elderly: prevalence, screening, diagnosis, and prognosis" New York: Oxford University Press 3-18, 1995
• 41 Oslin DW, "Alcohol-related dementia" 11 : 441-447, 2003
• 42 Stevenson JS, "Alcohol use, misuse, abuse, and dependence in later adulthood" 23 : 245-280, 2005
• 43 Culberson JW, "Alcohol use in the elderly: Beyond the CAGE. Part 2: Screening instruments and treatment strategies" 61 : 20-26, 2006a
• 44 Culberson JW, "Alcohol use in the elderly: Beyond the CAGE. Part 1 of 2: Prevalence and patterns of problem drinking" 61 : 23-27, 2006b
• 45 Atkinson RM, "Alcohol use in later life: scourge, solace, or safeguard of health?" 10 : 649-652, 2002
• 46 Schultz SK, "Alcohol use among older persons in a rural state" 10 : 750-753, 2002
• 47 Oslin D, "Alcohol related dementia: proposed clinical criteria" 13 : 203-212, 1998
• 48 Johnson I, "Alcohol problems in old age: a review of recent epidemiological research" 15 : 575-581, 2000
• 49 Liberopoulos EN, "Alcohol intake, serum uric acid concentrations, and risk of gout" 364 : 246-247, 2004
• 50 Choi HK, "Alcohol intake and risk of incident gout in men: a prospective study" 363 : 1277-1281, 2004
• 51 Lejoyeux M, "Alcohol dependence among elderly French inpatients" 11 : 360-364, 2003
• 52 Dufour MC, "Alcohol and the elderly" 8 : 127-41, 1992
• 53 Korrapati MR, "Alcohol and medications in the elderly: complex interactions" New York: Oxford University Press 42-55, 1995
• 54 Weatherman R, "Alcohol and medication interactions" 23 : 40-54, 1999
• 55 Holbert KR, "Alcohol abuse and dependence. A clinical update on alcoholism in the older population." 59 : 38-40, 2004
• 56 Atkinson RM, "Age-specific treatment for older adult alcoholics" Public Health Service, National Institute of Health 425-437, 1998
• 57 Babor TF, "AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for its use in parimary health care" Geneva: World Health Organization 1992
• 58 Varner JM, "ASNA independent study activity-substance abuse and the older adult" 30 : 15-16, 2004
• 59 O'Connell H, "A systematic review of the utility of self-report alcohol screening instruments in the elderly" 19 : 1074-1086, 2004
• 60 Jinks MJ, "A profile of alcohol and prescription drug abuse in a high-risk community-based elderly population" 971-5, 1990