[Early onset substance abuse disorders and addictive diseases in old age]. / Altgewordene Suchtkranke.

During the past 20 years substance-related and addictive disorders in old age have markedly increased and this increase is going to continue. It is quite common to make a distinction between early onset (EO) and late onset (LO) of these disorders. EO-addicts are in a more disadvantageous position due to constitutional and psychosocial burdens and the cumulating harmful medical, mental and social consequences of addiction place them at a further disadvantage during the course of the disorder. In old age they are at a disadvantage compared to others of the same age with LO addiction problems because of more and more severe chronic medical conditions, psychiatric comorbidity, less personal and social resources, dysfunctional coping style, and social problems. They present with lower treatment adherence and the treatment is difficult due to the combination of typical addictive behavior, psychiatric comorbidity, somatic diseases and in many cases also cognitive impairment. Treatment goals must be mostly individually defined and abstinence is rarely a realistic goal. Even the treatment has to be carried out mostly individually and often unconventionally. This article gives a review of the characteristic features of the course, presentation and adverse consequences of addictive disorders in EO addicts who have reached old age. The article covers alcohol, prescription drugs, illicit drugs and smoking as well as behavioral addictions.

[Discontinuation of benzodiazepines in old age : When and if so, how?] / Benzodiazepine absetzen im Alter : Wann und, wenn ja, wie?

Although viewed critically in geriatrics, benzodiazepine use is still common among old people. Before reducing the dosage the following questions must be considered: 1. Are there indications for benzodiazepine treatment and will discontinuation cause relevant rebound symptoms of the initial disorder treated? 2. To what extent do the patient and other key persons consider discontinuation to be reasonable and will they support discontinuation? 3. Is the target complete withdrawal, a dose reduction or shift to another benzodiazepine drug which is more suitable in old age for pharmacokinetic reasons? This article provides assistance in answering these questions and some guidelines for the practical management of discontinuation. It is mandatory 1) to periodically address the problem of long-term benzodiazepine use when counseling the patient and key persons and 2) to be aware that several intermediate steps exist between continuation and complete discontinuation, which may be considered successful treatment.

[Depression in old age, part 2 : Comorbidity and treatment]. / Depressionen im höheren Lebensalter, Teil 2 : Komorbidität und Behandlung.

Depression in later life unfavorably impacts on the prognosis of comorbid somatic medical conditions. There are mutually reciprocal risk relationships with several frequently occurring medical conditions, such as diabetes, ischemic heart disease, stroke and Parkinson's disease. A wide range of psychological and psychosocial interventions, drug treatment and other biological interventions are available for treatment, including special interventions for enhancement of effectiveness and therapy resistance.

[Depression in old age, part 1 : Origin, clinical symptoms, diagnosis and interaction between depression and dementia]. / Depressionen im höheren Lebensalter, Teil 1 : Entstehung, klinische Symptome, Diagnose und Wechselwirkung zwischen Depression und Demenz.

Depression is one of the most frequent mental disorders in old age. A huge variety of very different causal factors can contribute to late life depression as a common final outcome. The pathogenic pathways of depression overlap with those of frequent somatic medical conditions, such as diabetes and ischemic heart disease. Age-specific modulations of symptom presentation are described in this article with special emphasis on subthreshold depression and the complex mutual relationship between depression and dementia is presented.

[Alcohol in old age: Drinking habits, low risk drinking and alcohol-related disorders]. / Alkohol im Alter : Trinkgewohnheiten, risikoarmer Konsum und alkoholbezogene Störungen.

Alcohol abuse and health problems due to alcohol increase in the elderly. The functional impact is more pronounced than in younger people; nevertheless, alcohol abuse in the elderly is often overlooked. Early onset and late onset alcoholics differ with respect to previous problems, social and health status and therapy prognosis. The severity of withdrawal depends on addiction severity and comorbidities but not on calendar age. It is important to support patients in developing a motivation for change. Brief interventions are effective in elderly persons with an at-risk consumption of alcohol. Guidelines for low risk alcohol consumption recommend two alcohol-free days per week. There is no evidence for the popular hypothesis of the beneficial effects of light to moderate drinking. This hypothesis was drawn from former observational studies but recent large and more thorough methodical studies suggest that these former results were due to statistical bias. Alcohol consumption is a matter of pleasure and not a matter of medical treatment or prevention. The new German guidelines on "Screening, assessment and treatment of alcohol use disorders" contain for the first time a special chapter on the elderly.