Part 1: Mr. Smith Case Study “Mr. Smith is a 65-year-old male accompanied by his wife to your clinic. He is following up after an ER visit for a fall at home that resulted in 6 stitches to his forehead. He admits he had a few drinks that night before tripping over his dog. His […]
"Mr. Smith is a 65-year-old male accompanied by his wife to your clinic. He is following up after an ER visit for a fall at home that resulted in 6 stitches to his forehead. He admits he had a few drinks that night before tripping over his dog. His wife adds that he has “a few drinks” every night.
How will you proceed with Mr. Smith? What diagnostics will you perform? What will potentially be part of your treatment plan?..."
Falls are the leading cause of mortality and morbidity in the United States and are the second leading cause of accidental injury or death for patients older than 65 years old (Alshammari et al., 2018). An estimated 700,000 patients a year are hospitalized secondary to a fall injury which can cause serious injuries such as a fracture, head injury, or intracranial bleed (Alshammari et al., 2018). Falls are associated with environmental hazards such as carpets, rugs, poor stairway design, inadequate lighting, clutter, and slippery floors (Alshammari et al., 2018). However, the patient, Mr. Smith, appears to have fallen due to alcoholic drinks. The treatment would be aimed at preventing future fall incidents through alcohol cessation.
As the patient has fallen, assessing if the patient has a serious head injury, such as a fracture or intracranial bleeding, would be important. The provider should order a computed tomography (CT) scan to assess cerebral contusions, subdural hematomas, subarachnoid hemorrhages, or fractures requiring immediate intervention or monitoring (Silverberg et al., 2020). The provider may also want to order laboratory tests such as a complete blood count (CBC) to assess for infection, a comprehensive metabolic panel to assess electrolytes and liver function, and a lipid panel to assess for risk of cerebrovascular accident. The patient may be a long-term alcoholic in which the patient’s liver may be impaired and have thrombocytopenia, increasing the risk of subsequent hemorrhage. The provider can order magnetic resonance imaging (MRI) to further assess for a brain bleed secondary to the fall (Silverberg et al., 2020). Chronic
Chronic alcohol use has been shown to exacerbate hypertension and hyperlipidemia, increasing the risk of cardiovascular mortality (Lai & Pattanayak, 2017). The provider can use the CAGE-Adapted to Include Drugs, Alcohol Use Disorders Identification Test, or the Michigan Alcohol Screening Test Geriatric Version to screen for alcohol misuse in the geriatric population. Non-pharmacological approaches should be utilized first to treat alcohol misuse through interventions such as supportive therapy, motivation enhancement therapies, cognitive behavioral therapies, activity scheduling, support groups, and lifestyle changes (Lai & Pattanayak, 2017). If unsuccessful, providers can prescribe short-term treatment of benzodiazepines such as lorazepam 4 mg over the course of 7-10 days with a gradual taper (Lai & Pattanayak, 2017). If long-term treatment is needed, disulfiram may be prescribed as a deterrent agent to alcohol but is used with extreme caution (Lai & Pattanayak, 2017).
Response to Discussion 1
I appreciate your identification of the need to assess the patient’s frequency of alcohol consumption to develop an appropriate intervention. You identify that the presentations indicate a possibility that he consumes alcohol often, indicating a possibility for the presence of an alcohol use disorder. According to Carvalho et al. (2019), alcohol use disorder is characterized by repeated alcohol consumption despite legal, social, or health issues resulting from alcohol consumption. The patient presents to the clinic complaining of a fall due to alcohol use despite receiving treatment for a similar condition on his previous visit. As such, it is important for the clinician to engage the patient in a discussion concerning his frequency of alcohol use, how alcohol affects his behavior, and his willingness to reduce alcohol intake. Also, since consuming alcohol and other illicit drugs increases the risk of addiction, it would be important to identify other drugs that are used alongside alcohol (Delgado-Lobete et al., 2020, p. 3019). Gathering such information could help to establish a possibility for the presence of an alcohol use disorder. Therefore, you present useful insight concerning an appropriate diagnostic procedure for the patient.
References
Alshammari, S.A., Alhassan, A.M., Aldawsari, M.A., Bazuhair, F.O., Alotaibi, F.K.,
Aldakhil, A.A., & Abdulfatah, F.W. (2018). Falls among the elderly and their relation with their health problems and surrounding environmental factors in Riyadh. J Family Community Med, 25(1), 29-34. doi:10.4103/jfcm.JFCM_48_17.
Carvalho, A. F., Heilig, M., Perez, A., Probst, C., & Rehm, J. (2019). Alcohol use disorders. The Lancet, 394(10200), 781-792. https://www.sciencedirect.com/science/article/pii/S0140673619317751
Delgado-Lobete, L., Montes-Montes, R., Vila-Paz, A., Cruz-Valiño, J. M., Gándara-Gafo, B., Talavera-Valverde, M. Á., & Santos-del-Riego, S. (2020). A mediating analysis is the individual and environmental factors associated with tobacco smoking, alcohol abuse, and illegal drug consumption in university students. International journal of environmental research and public health, 17(9), 3019. https://www.mdpi.com/701708
Lai, R. & Pattanayak, R.D. (2017). Alcohol use among the elderly: Issues and
considerations. Journal of Geriatric Mental Health, 4(1), 4-10.
Silverberg, N.D., Iaccarino, M.A., Panenka, W.J., Iverson, G.L., McCulloch, K.L., O’Connor,
K.D., Reed, N., & McCrea, M. (2020). Management of concussion and mild traumatic brain injury: A synthesis of practice guidelines. Archives of Physical Medicine and Rehabilitation, 101(2), 382-393. doi:10.1016/j.apmr.2019.10.179
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Published On: 01-01-1970
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