# Alcohol use disorder and co-occurring mental illness among older adults in low-and middle-income countries: a narrative systematic review

## TL;DR

This paper reviews how alcohol use disorder and mental illness affect older adults in low- and middle-income countries, highlighting gaps in research and care.

## Contribution

The study systematically reviews the limited literature on dual diagnosis in older adults in low- and middle-income countries.

## Key findings

- Men are more likely to use alcohol, while women face higher rates of depression and cognitive issues.
- Key factors include lower education, living alone, chronic illness, and psychosocial stressors.
- Most studies are cross-sectional and lack culturally responsive interventions.

## Abstract

Alcohol use disorder (AUD) and co-occurring mental illness present complex and growing challenges among older adults, particularly in low-and middle-income countries (LMICs), where health systems often lack adequate resources and tailored interventions. Despite the rising prevalence of dual diagnosis in older adults, research on this issue remains limited in LMICs contexts.

A narrative review with systematic search was conducted and the reporting was adapted from the preferred reporting items of 2020 for systematic reviews guidelines where applicable. Literature was searched using online databases including PsycINFO, MEDLINE(Ovid), Embase (OVID), CINAHL, Scopus, and Web of Science. A google scholar search engine and reference lists of relevant studies were also manually searched.

The included studies reported substantial variation in prevalence rates of alcohol use and dual diagnosis among older adults, reflecting differences in definitions, measurement tools, and population characteristics. Gender differences were consistently identified, with men more likely to engage in alcohol use, while women experienced higher rates of depression and cognitive impairment. Key associated factors included lower education, living alone, chronic illness, tobacco use, and psychosocial stressors. Mental health outcomes commonly co-occurring with AUD included depression, cognitive impairment, poor sleep and suicidal ideation. Significant gaps exist in LMIC research on the care needs of older adults and healthcare providers in managing dual diagnosis. Most existing studies are cross-sectional and rely on self-reported data, with limited attention to culturally responsive interventions.

This review shows that AUD and co-occurring mental illness are significant yet understudied public health challenges. It highlights gender differences in drinking patterns, multiple psychosocial and health related contributors in LMICs. Most available studies are cross-sectional and concentrated in a few settings, which limits broader interpretation. Future research should focus on more rigorous and culturally grounded research is needed to better understand these complexities and guide appropriate interventions.