| Principal Investigator: | Joanne S. Stevenson, PhD, RN, FAAN |
| Organization: | Mount Carmel College of Nursing |
Abstract
Problem
An assessment tool developed from research findings was evaluated to detect alcohol abuse and over-the-counter (OTC) drug misuse among older women. Investigators have shown that physicians and nurses perform inadequate alcohol histories and ignore alcohol-related physical stigmata among older women — ignoring increased risks for heart disease, cancer, and liver damage among female alcohol abusers. Community-dwelling women (mean age 69) were interviewed, physically assessed, and had blood samples tested. The final sample was 134 with 67 women drinkers and 67 abstainers.
Strategy
The assessment tool was tested to determine validity and utility. Geriatric nurse practitioners performed physical examinations and collected other data. Contrary to prevailing myth, older women drinkers were forthcoming about frequency and quantity of their alcohol intake. These women seemed oblivious to any danger from alcohol abuse. They bought into the media message that wine promotes good health.
Practice Change
All critically ill patients over the age of 18 years were eligible to be placed on the tight glycemic control protocol.
Results
A score above zero on the T-ACE, a four-item scale of drinking effects, best discriminated between non-drinkers/drinkers, and between light and heavy drinkers. Other significant predictors of abuse were regular use of certain OTC drugs, using alcohol to sleep at night, shorter time required to fall asleep, and a history of smoking and caffeine use. Mean corpuscular volume was the best biomarker; broken blood vessels in the nose and cheeks, palmer erythema, and liver span above 7cm were the best physical indicators. Outcome was a modified assessment tool that (1) elicits specifics about alcohol and drug intake, (2) lists blood tests that discriminate to some degree, and (3) assesses for alcohol-related physical stigmata.
Recommendations
The final tool could help health-care providers ask non-threatening questions and do simple physical tests that suggest alcohol abuse. Assessment of alcohol habits should be done consistently in both primary and acute care settings to enhance case finding of older women alcohol abusers.
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