ALCOHOL ABUSE AND WITHDRAWAL SYNDROME IN THE ELDERLY

What to look for

Healthcare professionals need to have an understanding of what to look for in an elderly client who may be showing signs of alcohol abuse By knowing and understanding the definition, signs and symptoms, diagnosis and treatment, and prevention of alcohol abuse and withdrawal syndrome health-care professionals make themselves better prepared to meet the needs of these clients.

DEFINTION:
Alcohol abuse is defined as continued use of the substance despite social, economic, or legal pressures. Alcohol dependence is defined as alcohol abuse in conjunction with physiological manifestations, such as tolerance, or the requirement of greater amounts to achieve the same desired effects. (Wan et., al 2012).

SIGNS AND SYMPTOMS

The most serious symptom of alcohol withdrawal syndrome is delirium tremens (DTs). AWS (alcohol withdrawal syndrome) eventually will progress to tachycardia, diaphoresis, and hypertension as the withdrawal to the body worsens. Clinical symptoms can begin within sixeight hours, but the DTs typically do not progress until after 2 or more days. Symptoms may progress to more severe forms characterized by seizures and coma; in these forms, cardiac arrest and death occurs in 5 % to 10 % of patients.

When withdrawal symptoms may appear:

Signs and symptoms: Minor withdrawal: Onset after last drink 6 to 36 hours

Seizures:
Alcoholic hallucinosis: DTs:

6 to 48 hours
12 to 48 hours 48 to 96 hours

Diagnosis
Treatment can start as soon as those at risk are recognized. Questionnaires and scales exist to aide healthcare professionals in identifying patients at risk for alcohol abuse and AWS.

Treatment
The most commonly used treatment for Alcohol Withdrawal Syndrome is benzodiazepines. They are considered the foundation of alcohol withdrawal management. Acting both by treating agitation and by preventing progression of withdrawal to seizures and dts. Lorazepam, Diazepam, Midazolam and chloridiazepoxide are most often embraced by healthcare providers in treating AWS.

Prevention:
Prevention of Alcohol Withdrawal Syndrome is important to the continued care of elderly patients who abuse alcohol. Baclofen is currently being studied as a method of preventing the desire for alcohol which, in turn, would decrease the incidence of AWS. It is important for healthcare providers to look for behaviors in the elderly that make them risks for Alcohol Withdrawal Syndrome. A patient with a history of alcohol abuse, excessive daily consumption of alcohol, AWS or DTs, or early signs of alcohol withdrawal symptoms would be a high risk for AWS.