Koppel C., Zimmermann L., Tenczer J.^*, Wrobel N.^**

Poison Information Center, Virchow-Klinikum, and Geriatric Clinic, Max Burger Centre, Berlin
^*Institute of Forensic Medicine, Berlin
^**Geriatric Clinic, Klinikum Bremen-Nord, D-14059 Berlin, Germany

Substance abuse is frequently considered a problem of younger individuals. However, this attitude underestimates the relevance of abuse-related medical problems in elderly patients admitted to a geriatric clinic. An alcohol withdrawal syndrome (AWS) or benzodiazepine withdrawal syndrome (BWS) may dramatically complicate the clinical course in patients admitted to a geriatric clinic for acute stroke, cerebral hemorrhage, cardiac decompensation or other disease. Since early identification of patients at risk for AWS or BWS is of utmost importance for early treatment, we evaluated our experience of a geriatric clinic.
Methods. 120 patients (mean age 78.9 years) admitted to a geriatric clinic were included in the study. AWS or BWS was assessed by questioning of the patients and their relatives, urinalysis, and determination of carbohydrate-deficient transferrin (CDT). In addition, symptoms of AWS or BWS were assessed by the clinical instrument of withdrawal assessment (CIWA).
Results. Alcohol abuse was admitted in 5.6% of all cases, benzodiazepine abuse in 0.8%. On the basis of the CIWA criteria, two cases of AWS were identified but no BWS.
Conclusions. A careful diagnostic procedure including toxicological analysis is required for identification of substance abuse in geriatric patients. Alcohol is the substance most frequently abused by geriatric patients.