RICHMOND -- Apreoccupation with treating alcoholic youths and young adults has obscured the equally serious problem of alcoholism among the elderly, experts say. "Alcoholism in the elderly is drastically underdetected and undertreated," said Nancy J. Osgood, a Medical College of Virginia gerontologist who studies the issue. "We have a hard time thinking a person 85 years old could have an alcohol problem."

Osgood and officials at the Virginia Department for the Aging have developed what they say is the nation's first statewide program to detect alcoholism among the elderly. Their aim is to train 12,500 relatives of older alcoholics, as well as the elderly and social service and health workers, in the physical and psychological effects of alcohol and aging. Delaware is setting up a similar program modeled on Virginia's, according to Osgood.

Studies have found that as many as 10 percent of Americans over 65 are alcoholics. But, Osgood said, the statistics are misleading because the problem is largely hidden. "The elderly don't usually come in contact with officials at work or even with family members because they live alone," she said. Many older people also grew up believing alcoholism was a moral issue -- not a chronic disease -- and that overcoming it was a matter of willpower. This makes it hard for them to seek help.

It's sometimes difficult for physicians to distinguish symptoms of alcoholism -- such as memory loss and blackouts -- from the natural aging process, Osgood said. Many physicians also are reluctant to recognize alcoholism in the elderly or to confront an older patient, she added.

A more insidious barrier to detecting and treating alcoholism among the elderly is an attitude of "the bottle is the only thing they have left . . . why take it away from them?" Osgood said.

J. James Cotter, director for program development and management for the state Department for the Aging, agreed. "There is a tendency to use age as a justification for not seeking stronger intervention and providing help," he said.

Taken to an extreme, Osgood said, some people believe, " 'Why treat it, they're going to die anyway.' It's a crazy kind of rationalization." Among the clues to alcoholism in the elderly are repeated falls, gaps in memory, confusion, a flushed face, trembling, weight loss, extreme fatigue, incontinence, aggressive or abusive behavior and depression.

The goals of intervention are to allow a person to become aware of the problem, to enhance his or her motivation to recover and to help the alcoholic overcome fears of the disease and treatment. Intervention may take only a single meeting or many visits over a period of months.

An irony of the failure to detect alcoholism in old people is that they have a better treatment prognosis than other age groups, Osgood said. Most geriatric alcoholism is related to a specific problem, crisis or stress related to aging rather than to a lifetime of drinking, she said. Still, elderly alcoholics are more at risk for associated illnesses, such as liver damage and gastrointestinal problems, because their bodies are weaker.

Another physical threat is the sometimes lethal intereaction between alcohol and prescription drugs.

According to Cotter, geriatric alcoholism will worsen as life expectancy increases. "It's going to cost a fortune to take care of elderly alcoholics," Osgood said. "The drain on social services and the health care system in terms of money will be extremely high. The human cost in terms of quality of life" will be even higher.

As with geriatric suicide, alcoholism among the elderly mostly affects men. Male alcoholics make up 88 percent of the elderly who receive treatment. "In our society men, more than women, have held positions of power, status and authority. So when they become old and lose their jobs and income and the status and power {associated with them}, they've got the farthest to fall," Osgood noted.

Social factors may also make alcoholism harder to spot among elderly women. "I think . . . we probably have many more women alcoholics than we've recognized because traditionally we haven't even had programs for women alcoholics," she said. "As a society, we say 'nice women don't drink.' We don't want to admit that our grandmother is an alcoholic."