Elsevier

Geriatric Nursing

Volume 26, Issue 3, May–June 2005, Pages 176-183
Geriatric Nursing

Identifying and managing acute alcohol withdrawal in the elderly

https://doi.org/10.1016/j.gerinurse.2005.03.018Get rights and content

In the elderly population, alcohol-related problems may be misinterpreted as normal consequences of aging. However, alcohol is a commonly abused substance among older adults, and age-related changes predispose these patients to a greater sensitivity to its effects. All older patients should be screened for alcohol dependence and abuse on admission to an acute care facility. If identified, the plan of care must include close observation for acute alcohol withdrawal and prompt intervention if it occurs.

Section snippets

Defining abuse and dependence

In the past, the term “alcoholism” loosely referred to alcohol abuse, dependency, and addiction. In 1977, the World Health Organization (WHO) recommended abandoning that term5; since then, the more specific terms of “alcohol dependence” and “alcohol abuse” have been used.

According to the DSM-IV criteria,6 alcohol dependence refers to a maladaptive pattern of repetitive heavy drinking, leading to clinically significant impairment or distress. This pattern includes at least 3 of the following: 1)

Essential components of history taking

Nurses must become comfortable asking elderly patients about their use of alcohol; all patients admitted to an acute care unit should be screened for alcohol abuse and dependence. Nurses who are knowledgeable about the risk for acute alcohol withdrawal tend to be less anxious in caring for such patients.8 To establish open communication, a nonthreatening and nonjudgmental professional approach is essential. When asking questions about alcohol use, nurses need to be attentive to patients'

Essential components of physical examination

The physical examination can provide further support for the diagnosis of alcohol dependence and abuse. Along with noting the patient's general appearance, the nurse should be cognizant of an odor of alcohol on the breath when the older patient is admitted. When the smell of alcohol is detected upon entering the patient's room, the blood alcohol level may be greater than 125 mg/dL; this level is associated with problem drinking.13 Other obvious symptoms include poor coordination and balance,

Examination of laboratory values

On admission, blood testing can also provide evidence of excessive alcohol use.13 Alcohol's effect on the bone marrow and folate metabolism increases the mean corpuscular volume (MCV); anemia and thrombocytopenia may also be present. Alcohol's effect on the liver causes an increase in liver enzymes, most notably the gamma-glutamyl transferase (GGT); typically the aspartate aminotransferase (AST) increases up to double that of the alanine aminotransferase (ALT). Excessive alcohol consumption

Manifestations of acute alcohol withdrawal

If the nurse suspects or confirms alcohol abuse or dependence after completing the admitting history, physical examination, laboratory testing, and CAGE questionnaire, the plan of care must include observing for acute alcohol withdrawal. The manifestations of withdrawal vary greatly among individuals but may be more severe and last longer in the elderly; the duration of excessive drinking and amount of alcohol intake are important considerations.

Minor withdrawal, also called withdrawal

Pharmacologic interventions

The most safe and effective medications for use in preventing major alcohol withdrawal are the benzodiazepines.20 Because they exert a depressant effect similar to alcohol on the neurotransmitters in the brain, benzodiazepines serve as a substitute for alcohol; therefore, withdrawal symptoms are minimized and the incidence of delirium and seizure is reduced.18, 21 For elderly patients, short-acting benzodiazepines such as lorazepam (Ativan) or oxazepam (Serax) are preferred.19 As with other

Nonpharmacologic interventions

Close physical and mental status assessment, as well as vital sign monitoring, are essential in the care of the elderly patient at risk of acute alcohol withdrawal. Nonpharmacologic interventions include keeping the room as quiet and calm as possible, diminishing unnecessary stimulation, and providing frequent reorientation. It is helpful to keep consistent staff members; these individuals should have a supportive, caring, and reassuring demeanor. Although used in the past for patients with

Issues in discharge planning

A multidisciplinary approach is recommended for elderly patients when discharge planning from the acute care facility is initiated. All team members recognize that addictions are characterized by the defense mechanism of denial; an important approach is to discuss the patient's dependence on or abuse of alcohol in the context of the patient's overall health. Physicians and nurses begin teaching about the importance of abstaining from alcohol, reinforcing an understanding of the negative

References (22)

  • KostenT et al.

    Management of drug and alcohol withdrawal

    New Engl J Med

    (2003)
  • American Medical Association Council on Scientific Affairs

    Alcoholism in the elderly

    JAMA

    (1996)
  • AdamsW

    Interactions between alcohol and other drugs

  • MukamalK et al.

    Alcohol's effects on the risk for coronary heart disease.

    Alcohol Res Health

    (2001)
  • World Health Organization

    Manual of the international statistical classification of diseases, injuries, and causes of death

    (1977)
  • American Psychiatric Association
  • Burns M, Price J, Lekawa M. Delirium tremens. Available from: http://www.emedicine.com/med/topic524.htm. Accessed...
  • PatchP et al.

    Alcohol withdrawal in a medical-surgical setting: to “too little, too late” phenomenon.

    Med Surg Nurs

    (1997)
  • EwingJ

    Detecting alcoholism: A CAGE questionnaire.

    JAMA

    (1984)
  • DufourM

    What is moderate drinking? Defining drinks and drinking levels.

    Alcohol Res Health

    (1999)
  • WeathermonR et al.

    Alcohol and medication interactions.

    Alcohol Res Health

    (1999)
  • Cited by (19)

    • Alcohol use disorders in the elderly: A brief overview from epidemiology to treatment options

      2012, Experimental Gerontology
      Citation Excerpt :

      Beta-blockers (i.e. atenolol) have been proven to be effective in controlling tachycardia or hypertension, but should be used with caution due to the elevated risk of hypotension in the elderly population. In cases of delirium tremens, the administration of 30–60 mg/day of diazepam i.v., magnesium, thiamine 100–250 mg/day i.v., and electrolytes (if necessary) is warranted (Letizia and Reinbolz, 2005). The goals of rehabilitation for AUDs are the same as for any chronic relapsing disorder: to help keep motivation high, to change attitudes toward recovery, and to reduce the risk of relapse.

    • Delirious disorders of toxic origin in elderly patients

      2010, NPG Neurologie - Psychiatrie - Geriatrie
    View all citing articles on Scopus
    1

    MARIJO LETIZIA, PhD, RN, C, APN, is affiliated with Loyola University Medical Center in Chicago, Illinois.

    2

    MAGAN REINBOLZ, BSN, RN, is affiliated with Loyola University Medical Center in Chicago, Illinois.

    View full text