BACKGROUND: Alcohol use and alcohol use disorder (AUD) among older women (defined as age 50 and over) have increased substantially in recent years. Compared to men and younger women, older women negotiate biopsychosocial transitions that put them at greater risk of alcohol-related health conditions as they age and are less reliably screened and treated for heavy alcohol use and AUD.

OBJECTIVES: This scoping review represents a critical evaluation of research methodology and findings since 2004 on biopsychosocial correlates and consequences of alcohol misuse (i.e., heavy alcohol use, defined as four or more drinks on any day or eight or more drinks per week; and/or AUD) among older women. These findings, with a focus on their implications for treatment and prevention strategies among this at-risk population, are discussed. The goal of the review is to summarize current research as well as treatment and prevention options available for older women and to identify gaps in the literature and potential for future research.

ELIGIBILITY CRITERIA: 2,579 research articles were reviewed for inclusion in the paper. Inclusion criteria required that a study's findings were relevant to the review's objectives, with analyses and results that had clinically relevant findings for older women with heavy alcohol use and/or AUD.

SOURCES OF EVIDENCE: Authors searched PubMed, Embase, and PsycInfo for articles published between January 1, 1994, and August 5, 2024.

CHARTING METHODS: Two authors developed the template for data extraction, and four authors charted data. Weekly meetings were used to establish, monitor, and maintain calibration among authors.

RESULTS: 127 articles met inclusion/exclusion criteria and were included in the final extraction and results summary. Evidence-based information is presented on (1) clinical presentation of older women with alcohol misuse; (2) biological correlates of alcohol use in older age; (3) psychosocial correlates and consequences, such as mood disorders, social networks, and other substance use; (4) increased risk of health conditions, such as breast cancer and depression; and (5) current state of treatment and prevention needs and efforts.

CONCLUSIONS: The research reviewed here indicates a need for further age- and sex-specific research in the field of alcohol use and AUD. After age 50, men and women continue to differ in important ways in relation to the correlates, consequences, and treatment of alcohol misuse. The current literature includes significant methodological limitations and inconsistencies. Research with samples of older women who drink at heavy levels may be particularly helpful in addressing these limitations. Existing prevention and treatment interventions may be good options for older women, but more research is needed.