On Older People Drinking

This is completely out of field for us but this blog may have readers who are also confronted with the problem of alcohol abuse by elderly persons. I read this interesting article today and I am lifting some key points here. My questions are, how one seeks medical attention for someone else, even if this is in their best interests, if they would experience that as a form of assault or violation? and, how can one be sure what is in someone else’s best interests?

ROLE OF FAMILY MEMBERS IN CARE OF ELDERLY ALCOHOLICS

+ Seek medical attention for decline in patient’s cognition or self-care.
+ Corroborate information on recent and lifetime drinking problems.
+ Participate if confrontation is needed.
+ Provide support during detoxification and chronic treatment.
+ Assist in coordination with community services at home.
+ Make decisions for older alcoholics with impaired cognition who are unable to process information, weigh consequences or communicate decisions.

ADVICE FOR PHYSICIANS

+ The loss of lean body mass related to aging may reduce the volume of alcohol distribution, resulting in an increased peak ethanol concentration with any given dose of alcohol.

+ One complication of alcohol abuse is gastrointestinal trouble.

+ There are problematic interactions with many commonly prescribed drugs. For drugs with narrow therapeutic indexes, such as warfarin (Coumadin) or anticonvulsants, unpredictable clearance can have particularly hazardous consequences.

+ A decrease in sensory input and foot drop can occur with peripheral neuropathy, which along with cerebellar damage causes the classically described wide-based ataxic gait.

+ Alcoholic patients experience disturbed sleep, with insomnia, restlessness and suppression of rapid-eye-movement sleep. Concomitant psychiatric illness, including depression, is common among older adults who abuse alcohol.

+ Physicians should keep in mind that geriatric patients with alcohol abuse or dependence may present with new or increasing cognitive decline or self-care deficits.

+ Benzodiazepines are the mainstay of pharmacologic management of alcohol withdrawal; they can be administered on a fixed schedule or as symptoms occur. Some experts recommend shorter-acting benzodiazepines for elderly patients; longer-acting benzodiazepines can cause prolonged and excessive sedation because of pharmacologic changes related to aging. Concomitant treatment during detoxification includes thiamine and other vitamin supplementation, correction of electrolyte disturbances and general supportive care. Judicious doses of neuroleptic medication may be required if hallucinations occur.

+ Naltrexone (Trexan) is an opiate antagonist that reduces cravings, but its role in the treatment of older alcoholics had not been established as of 2000 CE.

+ Family physicians should assess the resources and limitations of their patients, coordinate care with interdisciplinary team members and recommend treatment options. Family members have an important role in the treatment of elderly alcoholics and should have access to support and education about alcoholism. Physically or cognitively frail elderly patients may benefit from comprehensive geriatric assessment and referral to appropriate community agencies for home care, nutritional programs, transportation and other services.

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8 Responses to On Older People Drinking

  1. Hattie says:

    I’m sorry you are going through this. My mother was an alcoholic. She started drinking heavily in her 40’s and managed to hide her condition for many years. My sister found the bottles in the trash one day, and then we understood the cause of her deterioration, which we had, of course, attributed to age.
    Mobilizing everyone in sight to rescue an elderly alcoholic may not be the best use of human resources, I think.

  2. Z says:

    Not the best use of human resources, no indeed. Some people think my parents should be helped more but they don’t realize the main problems aren’t geriatric problems, and that they predate even my august existence. Thanks Hattie…

  3. Hattie says:

    You are welcome. And I am following you on Twitter now.

  4. Z says:

    …but I hardly ever tweet!😉

  5. Hattie says:

    I have tweeted maybe twice since I opened my account. I use it mostly to follow politics (Chris Hayes, The Nation, Naomi Klein, Democracy Now and others) + The New York Review of Books and McSweeney’s.
    I use Facebook for friends and family. I stopped friending people at one point, because I couldn’t keep up with all the postings, but I’ll try re-friending you on Facebook, if you are interested.

  6. Z says:

    Sure, friend me! I use FB more as a community bulletin board, most people on it are friends and acquaintances in town saying hey — I want to go kayaking, is anyone up for that right now? But I do go on it, and I just haven’t found time for Twitter…

  7. Z says:

    Although I should use Twitter for news, I do suppose. My FB friends post news articles which is one of the reasons I like it, it’s sort of a news digest in my case. But Twitter would be good for this… I just don’t like all the people making context free comments about what they are doing right now, it is boring and I find it intrusive somehow…

  8. Hattie says:

    If you choose the right people, Twitter is great for following politics. I don’t really mind dumb comments on Facebook, if they are my friends.

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