President's Message:Joanne Alderman, April 2017

By Joanne Alderman, MSN,RN,BC,APRN, FNGNA

NGNA Members,

April is Alcohol Awareness Month

Joanne Alderman, MS-N, APRN-CNS, RN-BC, FNGNA

During the month of April, Alcohol Awareness Month, we are addressing the subject of Alcohol Dependence and the Older Adult. According to the NIH, a national survey in 2008 demonstrated that about 40% of individuals 65 y/o and older consume alcohol. This portion of the article will discuss risk, assessment and includes several references.

As Nurses, we are acutely aware of the importance of screening as part of our assessment during patient visits. There are many risk factors associated with supporting the development of alcoholism or the reliance on alcohol in an older adult’s life. These factors can include loss of a loved one, retirement, decreased sociability/isolation. Having a long history of a mental health disorder can also add to the risk. Pain, that is persistent and of any origin, coupled with poor management, geriatric syndromes such as poor eyesight, loss of hearing, functional losses, an extensive history of depression or anxiety, inability to sleep (insomnia), and short term memory loss (cognitive impairment) are risk factors that need to be explored with our patients and their families.

Low risk is considered if an older adult states, during screening, that they only have one drink each day and a maximum of only two drinks on a single occasion. According to the American Medical Association Guidelines (1) for screening, the patient can be asked: “How often do you have a drink containing alcohol?” If the reply is positive then ask, “How many days per week?” “On a typical day how many drinks?” “How often do you have three or more drinks on one occasion?” A screening tool used extensively is the non-complex 4-item CAGE questionnaire. When, following an assessment, it can be determined that the patient does drink alcohol, these questions can be presented: “Have you ever felt you should cut down on your drinking?” “Have people Annoyed you by criticizing your drinking?” “Have you ever felt guilty about your drinking?” “Have you ever taken a drink first thing in the morning (eye-opener) to steady your nerves or get rid of a hangover?” Noting a positive response to any of the four questions demonstrates a possible problem with the use of alcohol and supports further assessment/investigation.

Two additional screening tools include – Short Michigan Alcoholism Screening Test – Geriatric Version can be found online. Adult screening can also be done through the Alcohol Use Disorders (AUD) Identification Test. This tool is useful in primary care and can be found at this website.

A general assessment series, Try This, speaks to Best Practices in Nursing Care to Older Adults. Issue Number 17, Revised 2012 – Alcohol Use Screening and Assessment for Older Adults can be found at the Hartford Institute for Geriatric Nursing, Clinical Nursing Website.

A problem of great concern is the combination of alcohol and Prescription Medications, in addition to over-the-counter (OTC), supplements. The aging physiology, changes in metabolism, chronic illnesses, and the high potential for drug interactions, places the Older Adult at an even greater risk. For additional information, please refer to this website.

This study will review the Epidemiology, Physiologic Effects, Alcoholism and Chronic Disease, and medications that may interact adversely with alcohol.

Sincerely, Joanne President, NGNA