“Functioning and Health Services Use” by Brennan

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The article “Functioning, Problem Behavior and Health Services Use among Nursing Home Residents with Alcohol-Use Disorders” by P. L., Brennan, and M. A. Greenbaum, describes and analyses problems and difficulties faced by nurses working with the elderly. In this article, special attention is given to problem behavior, and possible complications caused by alcohol abuse among the elderly.

The authors address one of the main problems faced by nurses and patients: alcohol abuse and alcohol-related disorders which influence communication and interpersonal relations. The authors underline that the perception that drinking is a sanctioned way to maintain social contact, which is preferable to not drinking and becoming isolated, is a very powerful consideration, particularly for men who are single-room occupants. The importance of this research is that “very few studies have focused on AUDs among nursing home residents” (Brennan and Greenbaum 2005, p. 395).

The authors admit that the problem is that drinking alcohol depletes the body of necessary nutrients and often replaces meals, thus making an individual doubly prone to malnutrition. It is thought that nearly half of the elderly hospitalized for unstable chronic medical problems are abusing alcohol and that many others consume enough alcohol to affect their health negatively. Successful screening of a patient’s alcohol use involves addressing the chronicity of disease as well as the degree to which the patient is affected by alcohol consumption. Alcohol use should always be considered when looking for factors associated with unstable chronic health problems (Gurnack et al 2001).

The article gives a literature review and is based on theoretical background. Using previous studies, the authors analyze such topics as health-related functioning, social functioning, falls, and problem behavior, health services use, and interaction of alcohol consumption and AUDs.

They come to the conclusion that many elders attempt, some quite successfully, to manage their disorders with over-the-counter medication combinations, doctor shopping, or simply by years of habitual codependency with a particular physician. Any of these methods can result in addiction and leave the elder vulnerable. The aim of the research is to expand previous knowledge and research data, and “examine whether the presence of an AUD diagnosis interacted with alcohol consumption to predict poorer outcomes, including elevated rates of falling, behavior problems and more health services use, among older nursing home residents” (Brennan and Greenbaum 2005, p. 395).

The research is based on both qualitative and quantitative research methods. The data is based on the VA Resident Assessment Instrument (RAI MDS) and VA Patient Treatment Files. For this research study, the authors identified: “22,074 VA nursing home residents ages 55 and older who had

a full MDS assessment conducted during the fiscal year 2002 (FY02) and
used inpatient and/or outpatient VA health services over the FY99FY02 interval” (395).

The taks of the data collection was to identify those patients who have developed a chronic disorder as if they could it away by the strength of mind, determination, and courage. Suffering a chronic illness is compounded by the sense of responsibility for being healthy, especially in the current wellness climate. There is often the persistent thought that hard work and adherence to a strict treatment regimen will bring about a cure, and when that does not occur, a sense of shame develops, and the person wishes to hide from others.

The data was assessed using the RAI MDS, “a comprehensive patient assessment instrument designed to monitor and guide clinical interventions to optimize health and psychosocial functioning of nursing home residents” (396). The researchers single out the following symptoms: depression, cognitive functioning, social functioning, falls and fracture, tobacco use. These results are analyzed using SPSS version 11.5 (SPSS Inc, Chicago, IL) to compare the health-related functioning.

The results show a significant difference between demographically matched controls and patients with alcohol abuse. Elders are likely to feel excessively guilty and regretful about alcohol misuse, and it is important to reach out to them with understanding. The notion that alcoholism is a genetic or metabolic disorder that can be cured only by a return to God may be useful to some, but we find elders responsive to activity enrichment and group support.

Risks of alcohol and medication mixtures have not been sufficiently emphasized with most elders. A primary goal of geriatric nurse practitioners should be prevented through the education of the provider community, families, and elders about these risks. Direct confrontation is likely to increase agitation, a sense of vulnerability, and the need for delusion. A more useful approach is to establish a trusting relationship that is non-demanding and not too intense and to identify the client’s strengths and build on them. Nurses need to reduce the alienation and feelings of insignificance that underlie paranoid ideation.

It is important that the nurse be trustworthy, that clear information is given, and that clear choice always is presented to the patient. When offering food, medication, treatments, or resources, relevant information should be given. When patients refuse “necessary” treatments, their decision must be respected. “The residents with an AUD were more likely to be hospitalized, make emergency room visits and obtain mental health services” (Brennan and Greenbaum 2005, p. 398).

The most important is that the research study rejects previous studies on this subject and proves that nursing staff and healthcare policies have little impact on alcohol abuse among the elderly. This is a serious problem, deeply rooted in the work ethic that has been so cultivated in the older generation. Also, in contrast to previous studies, the researchers prove that alcohol abuse worsens health problems among the elderly. The main limitation is that it focuses on VA nursing homes only.

This research study is well structured proposing a unique approach to the subject. It unveils that a sensitive nurse should be aware that the visible symptoms produce an undesired facade that may hide an alert and responsive individual who wishes to interact and generate interest.. The caregivers willingly talked about their difficulties, but the elders would rarely do so. This is extremely important for nurses to remember because the best source of information in these cases is apparently not the patient.

The most important fact is that this study contradicts previous researches on this subject. Further research is required to prove this theory and reject a series of research studies that state that alcohol does have a positive impact on the health of the elderly (Gurnack et al 2001).

These reactions are sometimes induced by alcoholism or medications, particularly male hormones in combination with antidepressants. The majority originate in attempts to exert control in an unsatisfactory situation or to feel capable. Inability to correctly evaluate the social milieu because of isolation or degrees of cognitive disturbance is a significant factor. the other limitation of the research is that the authors do not take into account the diseases and health problems of the patients. It is known that stress levels and excessive demands or cognitive impairment may trigger anxiety reactions. Often there are coexisting disorders such as delirium or early Alzheimer’s disease that produce anxiety.

References

Brennan, P. L., Greenbaum, M. A. (2005). Functioning, Problem Behavior and Health Services Use among Nursing Home Residents with Alcohol-Use Disorders: Nationwide Data from the VA Minimum Data Set. Journal of Studies on Alcohol, 66 (3), 395-399.
Gurnack, A. M., Atkinson, R.M.D., Osgood, N. (2001). Treating Alcohol and Drug Abuse in the Elderly. Springer Publishing Company; 1st edition.

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“Functioning and Health Services Use” by Brennan

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