Download Alcohol - Lewisham CEPN

Winter Pressures Event And Alcohol Dependence in Older Adults
Indra Macfarlane and Winston Rickman
Presented by:
CGL and Lewisham Community Education Provider Network
Date:
Tuesday 27th September 2016
Contents
© CGL 2016
1.
Definition of Alcohol Dependency
2.
Winter Pressure and Impact on Older Adults
3.
Wernicke's Encephalopathy / Korsakoff Syndrome
4.
Impact on Mental, Physical Health / Cognitive Impairment
5.
Signs and Symptoms of Alcohol Intoxication and Withdrawal
6.
Alcohol and Medications
7.
Top 5 Tips Referral pathway
Definition of Alcohol Dependency
• Alcohol addiction is defined as a chronic disease in which your body and
mind become dependent on alcohol. Though its definition is universal, its
effects mean different things to different people: job loss, family
estrangement, physical deterioration and mental health deterioration.
• People can feel very isolated in their addictions and continue not accessing
services as they are still able to hold down a job or daily life activities and
have some semblance of family life but this over time if not addressed can
lead to physical, mental, and social health deterioration.
• Physical dependence manifests itself to the individual as increased tolerance
to alcohol intake and physical withdrawals if not consumed in increasing
amounts.
• Older Adults may not be able to identify the consequences of alcohol use
due to being isolated in the community and only seeing loved ones
sporadically, therefore symptoms are not picked up; also they may be
hiding the fact they are drinking to avoid guilt and shameful feelings.
© CGL 2016
Winter Pressure and Impact on Older Adults
In relation to the cold weather and dependant alcohol use in older adults this can either cause an increase in
consumption or decrease in consumption. Consider the following:
Physical
Risk of falls – visible bruising to face, hands , knees etc
Deterioration in physical health
Wernicke's encephalopathy –confusion/ funny gait, odd eye movement
Poor diet and nutrition
Psychological
Loss of partner/ family members
Depression
Suicidal
Alcoholic Brain Damage – Korsokoffs Syndrome
Environmental
Lack of heating in home
Social/cultural isolation,
Financial abuse from others
Lack of social support from informal carers and friends.
Social pressure from debts
© CGL 2016
Wernicke's encephalopathy / Korsakoff Syndrome
WKS is a neurological disorder caused by thiamine deficiency, typically from chronic alcoholism or
persistent vomiting, and marked by mental confusion, abnormal eye movements, and unsteady gait.
Korsokoffs Syndrome is alcoholic brain damage characterized by disorientation and a tendency to invent
explanations to cover a loss of memory of recent events
Key point to remember is that in both prescribing Thiamine (Vitamin B 1) can help to prevent further
progression of Wernicke's / Korsokoffs.
•
Ensure that if you suspect that your patient is drinking alcohol daily and perhaps to a harmful level to
liaise with their GP and make sure they are prescribed Thiamine and ensure on your visits they are
taking this daily and can show you evidence of this.
•
If you suspect the patient has any of the above symptoms get them to A&E urgently!
•
Always inform the GP of any thing you are concerned around.
© CGL 2016
Impact on Mental, Physical Health and Cognitive Impairment
MENTAL
Anxiety/Depression
Psychosis/delusion
Demotivation
Low self-esteem
COGNITIVE
Confabulation:
Falsification of memory in clear consciousness.
Very characteristic of the syndrome.
Can answer questions promptly with inaccurate
and sometimes bizarre answers.
Memory loss
Anterograde amnesia:
A loss of memory for events occurring after the
onset of the disorder and the main feature of the
Memory loss
syndrome.
Unable to learn and repeat simple pieces of
Insomnia
information or learn new tasks.
Visual Hallucinations Often disorientated in time and place.
Mood swings
Korsakoff syndrome Retrograde amnesia:
Loss of memory for events before onset of
disorder.
Some memory of distant events may be preserved.
Telescoping of events is characteristic, e.g., client
says something happened recently when it
happened years ago.
© CGL 2016
PHYSICAL
Poor appetite
Stomach ulcers
Gastric
problems/complications
Stroke - Hypertension
Heart problems/conditions
Infertility
Gout
Pancreatitis
Fatty Liver
Liver disease/Cirrhosis
Diabetes
Sexual Dysfunction
Cancers
Oral Cavity
Pharynx
Colorectal
Liver
Breast
Oesophageal
Signs and Symptoms of Alcohol Intoxication and Withdrawal To Look For
INTOXICATION
Confusion
Loss of coordination
Vomiting
Irregular or slow breathing (less than
eight breaths a minute)
Blue-tinged or pale skin
Low body temperature (hypothermia)
Stupor (being conscious but
unresponsive)
Unconsciousness (passing out)
Slurring
Drowsy
Disorientation
© CGL 2016
WITHDRAWALS
Nausea and vomiting
Odour/vomiting/urine
Hypertension/Tachycardia
Seizures/Incontinence
Diarrhoea on clothing and floor
Sweats/Shakes/Anxiety
Fitful sleep
Delirium Tremens signs of altered
mental state – include
tactile/auditory/visual
hallucinations/confusion
/delusions/severe agitation
Alcohol & Medication
It is important to be aware of the following information about alcohol and its effects
when taking any form of medication.
Drowsiness caused by certain medications this is made worse by alcohol. Therefore,
alcohol should not be consumed while taking medication with this side effect. This
will be stated on the label.
Certain Antibiotics react with alcohol making the individual feel very unwell such
Metronidazole, causing stomach upset and vomiting.
Medication (Antabuse) administered to combat alcoholism can cause severe
reactions if consumed at the same time as very small amounts of alcohol.
Best advice do not drink alcohol with any medication! If you think your patient is
drinking alcohol with their prescribed medication ask them if they would like some
one to talk to around this and inform their GP who will pick this up and refer
accordingly.
TOP 5 TAKE TIPS
1. CGL Referral Pathway for all Suspected Alcohol Issues 0208 314 5566
CGL ALCOHOL LIASION TEAM 07799413873
2. NEVER ADVISE TO STOP DRINKING ALCOHOL SUDDENLY
Patients can go into alcohol withdrawals and begin to fit, after the patient stops fitting
place them in the recovery position and call an AMBULANCE.
3. Delirium Tremens – medical emergency and can be fatal if untreated. If your patient
appears confused, tactile/visual hallucinations, anxious, tremors, disorientation, high BP,
profuse sweating, CALL AN AMBULANCE IMMEDIATELY!
4. Alcoholic brain damage can be reversed if identified and treated with Thiamine (Vit B
1) thereby avoiding the development of further irreversible damage– ask their GP if
being prescribed Thiamine and then monitor the patient is taking it daily.
Nutritional advice and monitoring is important – ensure your patient is eating their 5 a
day and eating a balanced diet Thiamine–rich foods include meat (e.g., pork) and
poultry; whole grain cereals (e.g., brown rice and bran); nuts; and dried beans, peas,
and soybeans and also drinking plenty of water.
5. Drug and alcohol misuse are common problems in the community and need to be
treated with compassion
© CGL 2016