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.
+ 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.