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Kevin L. Kraemer, MD, MSc; Michael F. Mayo-Smith, MD, MPH; David R. Calkins, MD, MPP

Arch Intern Med. 1997;157(19):2234-2241.

Abstract
Background
Early identification of alcoholdependent patients at increased risk for severe or complicated alcohol withdrawal would improve triage and treatment. However, the role of age in predicting alcohol withdrawal outcomes has not been well studied.

Objective
To assess the impact of age on the severity, course, and complications of alcohol withdrawal.

Methods
We performed a retrospective cohort study of 284 inpatients admitted for alcohol withdrawal between September 1992 and August 1994. Outcomes included alcohol withdrawal severity measured by the revised Clinical Institute Withdrawal Assessment for Alcohol scale, quantity and duration of benzodiazepine therapy, and complications during withdrawal.

Results
Initial and maximal withdrawal severity scores, amount of benzodiazepine administered, and duration of benzodiazepine treatment for elevated withdrawal severity scores did not change significantly with age. However, patients aged 60 years and older had increased risk for delirium (adjusted odds ratio [OR], 4.7; 95% confidence interval [CI], 1.5-15.0; P=.008), falls (OR, 3.1; 95% CI, 0.9-11.2; P=.08), and transient dependency in 2 or more activities of daily living (OR, 5.8; 95% CI, 2.911.7; P<.001). As age increased, there were significant increases in length of stay (p<.001) and frequency of discharge to an extended care facility (P<.001).

Conclusions
Although alcohol withdrawal severity scores and benzodiazepine requirements were similar across age groups, patients aged 60 years and older were at increased risk for cognitive and functional impairment during withdrawal. These findings support recommendations that older patients with alcohol withdrawal are best treated in closely supervised settings.

Arch Intern Med. 1997;157:2234-2241

Author Affiliations
From the Division of General Internal Medicine, Deaconess Hospital (Drs Kraemer and Calkins), and Harvard Medical School (Drs Kraemer, Mayo-Smith, and Calkins), Boston, Mass, and Ambulatory Care Service, Veterans Affairs Medical Center, Manchester, NH (Drs Kraemer and Mayo-Smith). Dr Kraemer is now with the University of Pittsburgh Medical Center, Pittsburgh, Pa. Dr Calkins is now with the University of Kansas School of Medicine, Kansas City.

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