Wobbly
Heavy alcohol consumption can have negative effects on cognitive function - Wernicke's Encephalopathy is an acute neurologic condition from ____ and characterized by classic triad of :
thiamine deficiency
ophthalmoplegia, gait ataxia, confusion
Based on number of criteria met AUD is subclassified into:
mild (2-3 symptoms), moderate (4-5 symptoms), and severe (> or equal to 6 symptoms)
When elderly patient with chronic and severe alcohol abuse is in withdrawal, IV hydration is often necessary. If administering glucose dextrose IVF, what must be given concurrently to avoid precipitating Wernicke's encephalopathy?
glucose dextrose must be given concurrently with thiamine
Barriers to detecting AUD in geriatric patients
Stigma, shame (thinking alcoholism is a moral weakness), denial, providers may carry predisposed stereotypes of what a person with AUD should look like
Self-report questionnaires used to screen for AUD
AUDIT (alcohol use disorders identification test) - long and short forms (AUDIT-C); valuable when screening for harmful/hazardous drinking in pts older than 60 yrs
CAGE - 4 items; valuable when screening for dependence
Short Michigan Alcoholism Screening Test- Geriatric Version
This condition develops in 80-90% of chronic alcoholic individuals with Wernicke's Encephalopathy
What is Korsakoff syndrome - characterized by severe memory impairment, both retrograde and anterograde amnesia, confabulation
DSM-V lists alcohol-related dementia as
WHat is Alcohol-induced Major or Mild Neurocognitive Disorder
When placing geriatric patient on CIWA, which benzodiazepines would you pick? (bonus and why?)
Shorter-acting benzodiazepines (LOT) - more effectively metabolized owing to simpler hepatic degradation and safer to use in elderly patients who may have liver disease - Lorazepam more commonly used given IM formulation
According to the National Institute on Alcohol Abuse, this quantity is the maximum amount for "moderate" alcohol use for men and women 65 years of age or older
one drink per day (equivalent to 0.5mg oz alcohol, 1.5oz distilled spirits, 12 oz beer, or 5 oz wine)
findings that suggest problem drinking in elderly patients
cognitive decline, self-care deficits
nonadherence to med appointments and tx
unstable/poorly controlled HTN
recurrent falls, accidents, injuries
GI problems
unexpected delirium
estrangement form family
lab findings - increased MCV, elevated GGT
What medical conditions in the elderly may mimic alcohol withdrawal symptoms or co-exist with withdrawal symptoms?
Risk factors for AUD in elderly patients
What is: marital status (widowed/divorced), pain, financial strain, disability or chronic medical conditions, family history
True or False? A study performed looking into the efficacy of naltrexone as an adjunctive treatment for alcohol dependence in elderly adults found that naltrexone was well tolerated and efficacious in preventing relapse in subjects who drank compared to placebo-treatment subjects.
True - Oslin et al. 1997 (study published in The American Journal of Geriatric Psychiatry) found that naltrexone was well tolerated and efficacious as MAT in study group of veterans over the age of 50 years who were enrolled in a 12-week double blind placebo-controlled efficacy study - additionally no differences found in adverse effects or in liver enzyme values between placebo and naltrexone-treated groups
Although psychosocial interventions such as supportive or cognitive behavioral treatment are likely to be effective in older adults with alcohol abuse, there are no known strategies to address AUD in cognitively impaired elderly; what could be effective?
Providing structure to daily routine, removing access to alcohol, VNA or on-site support
reasons for a decrease in or spontaneous cessation of alcohol use among older persons
increased physiologic effects per drink
medical problems that limit accessibility or desirability of alcohol
financial strain
trend towards fewer social events that emphasize alcohol consumption
If benzodiazepines are not able to control symptoms alone in patients with severe alcohol withdrawal symptoms, which agent could be used for agitation?
Haldol - with caution; in addition Beta Blockers have been shown to be effective in controlling tachycardia and HTN (monitor d/t risk of hypotension in elderly pts)
Female patients following this procedure (which may be indicated in their history) are at increased risk for developing AUD later on in their lives (after age 50)
What is Bariatric Surgery (roux-en-y)
This medication assisted therapy option could lead to increased risk of adverse effects, especially tachycardia and hypotension in geriatric patients and should be used with caution
What is Disulfiram?
Some age-related biological and physiological changes that affect alcohol absorption, metabolism, elimination
What is decline in hepatic and renal function, reduced metabolic capacity, loss of lean body mass and increase in adipose tissue, brain vulnerability, greater risk of toxicity and drug-drug interactions
True or False - older patients with late-onset alcohol use are twice as likely as early-onset alcohol use to have stable remission from treatment
true - a longitudinal study of prognosis for elderly patients found an overall 21 % stable remission of late-life drinking at 4 years with late onset alcoholics almost twice as likely as early onset alcoholics to have stable remission from treatment