Alcohol, medications, and the older adult.

Late-onset alcoholism is a common occurrence in older adults and may be a consequence of life-changing events such as retirement, declining health, loss of independence, or loss of a loved one. Alcohol use and misuse often go unrecognized. Alcohol use can cause significant drug interactions and exacerbate underlying disease. Because of physiologic changes in older adults, alcohol pharmacokinetics and pharmacodynamics may be altered and contribute to adverse alcohol-induced clinical consequences. We report on an elderly man who may have had unrecognized alcohol-induced drug interactions, falling, and exacerbation of heart failure. Following a fall, he was admitted to the hospital. After discharge, the man and his wife relocated to an assisted living facility and he abstained from alcohol. Four months later the man received a prescription for a glass of wine or two with dinner; one week later after two glasses of wine, a dose of lorazepam was given. Later that evening the patient fell and suffered a subdural hematoma. The effects of alcohol in older adults are discussed.