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Cocktail Hour as an Inpatient

March 1, 2013

Today’s topic is not often addressed, but it is one that can have a significant impact on how your aging parents get through a hospital stay, admission to a rehab unit, or move to a long-term care facility. Those of us who advocate for seniors often speak about lifestyle choice and upholding the rights of individuals to choose their diets or their physical location. We rarely talk about lifestyle choice in terms of alcohol or smoking unless it’s to tout the unhealthy aspects of those choices.

Today I am going to address the Pandora’s Box of vices.

Fist let me tell you a story:

Susie is an 84-year old woman who lives alone. Her husband died a few years ago and she now manages their beautiful property by herself. She has no major health problems, eats well, gets plenty of exercise taking care of her large yard and gardens, and has two cocktails every night before dinner.

A few months ago Susie slipped on the ice while trying to bring in a load of firewood for the wood burning stove which is used for supplemental heat. She lay on the icy flagstone unable to move and there was a terrible pain in her leg. Looking down she could see that the leg was bent at an odd angle and she deduced she had a broken leg. Her cell phone was in her pocket so she dialed 911 and was taken to the local hospital.

Surgery was required and pins were placed in Susie’s leg and she was told that within a week she would be transferred to a rehab center for intense physical therapy and conditioning so her muscles would not atrophy and she would regain her ability to walk with a normal gait. Needless to say, Susie wasn’t thrilled with the prospect but she knew that in order to return to her home she needed to be able to ambulate independently and safely so she agreed.

While hospitalized she received round-the-clock pain medication which kept her comfortable and mildly sedated. She slept well, ate well, and remained strong. When she was discharged to the rehab hospital she no longer needed strong pain medication so was put on oral pain killers which did not sedate her, but did cover the pain. During her stay she was slowly weaned off of the pain meds as her pain level decreased. Susie was more alert and she was doing well with her physical therapy, but she was frequently agitated and became especially unhappy in the evening. The staff was at a loss as to what to do for her.

One evening as a nurse was doing an assessment just before dinner she asked Susie what she could do to help calm her down and make her stay more pleasant. Susie angrily replied, “Bring me a glass of ice with a splash of vodka, the rest water, and a twist of lemon.” She then wailed, “I miss my cocktail hour.” Unbeknownst to the staff, Susie’s  ritual cocktail hour was a psychological and physiological addiction for her. She’d been indulging in nightly cocktails for over sixty years and the change in routine had upset her system. On admission to the rehab hospital Susie had been asked about her intake of alcohol and she had answered honestly, but that was the end of it. No one had pursued it further.

 

What sort of habits do your parents have that might have a similar impact?

  • Does mom smoke a pack or two of cigarettes a day?
  • Maybe dad likes a cigar and a glass of brandy before bed
  • Is cocktail hour a ritual in your parents home?
  • Is that glass of wine mom relaxes with while reading something she could easily do without?
  • Were your parents hippies “back in the day” and still light up a joint every evening before bed?
  • Is the bar a daily stop on the way home from work for one, or both, of your parents?
  • Could the bottle of wine consumed nightly with dinner be termed an addiction?

Please understand, I am not out to make any judgments here and neither should you if you open a conversation on this subject. What I am suggesting is that if your parents are planning to have surgery, or an extended hospital stay, this is a topic that should be discussed. It is even more pressing if they are considering a move to an assisted living facility, long-term care center, nursing home, or family-style certified home.

Let’s say mom is a heavy smoker (1 1/2 to 2 packs per day) and will be hospitalized for approximately four days then transferred to a rehab facility for therapy. Her rehab stay is anticipated to be 4 – 6 weeks depending on her progress.  Has anyone explored whether mom will be able to smoke during her recovery? You know that she becomes very agitated in unfamiliar surroundings and that she is addicted to her cigarettes. Here’s a few things you might want to do as mom prepares for her surgery:

  • Talk to mom’s doctor and see if he thinks it will be ok for her to smoke during recovery
  • Call the rehab facility and find out their policy on smoking
  • If mom must be accompanied outside to smoke find out what the staff availability is for that. Are there set times or can she go out with a visitor?
  • Be sure to find out what the visiting hours are
  • If the weather is cold make sure mom plans to take along a coat if she has to go outside to smoke
  • Let family and friends know when the best times to visit will be so they can assist mom with her smoking activities if required
  • Talk to mom and see if she could attempt to cut back on daily smoking habit. If she smokes two packs per day, but is only going to be allowed outside 6 times a day to smoke that will be a huge adjustment unless she is prepared for it
  • Reassure mom that you are not judging her, or her habit, but that you want her surgery and rehab to be as successful as possible with as little stress as possible and this is one way to achieve that goal

The further ahead you start exploring these options the more likely there will be a positive outcome for all.

 

Supporting lifestyle choice and promoting good health = Win-Win for all!

Once Susie’s dependence on her nightly cocktail was understood the nurse spoke with the doctor and a call was made to the facility Administrator. Since her cocktail would not interfere with the current pain medications she was taking and the facility was open to letting her have a cocktail before dinner the problem was solved. Susie’s agitation decreased, she continued to gain strength and was released home after four-and-a half weeks of therapy.  Everyone was happy. If the right questions had been asked by Susie on admission and during the assessment process Susie’s initial agitation could have been avoided.

Not all outcomes will be as successful. You may run up against facilities with very hard and fast rules that they will not budge on. If that is the case seek options such as another facility or an alternative method of treatment. In the case of a heavy smoker maybe the doctor could order a nicotine patch during the hospitalization or the patient might use one of the new electronic cigarettes. There are always options and choices if we are willing to persevere and look outside the box. 

Lifestyle choice is a personal matter. Allowing patients to feel that they are respected and valued is part of good caregiving. An individual who feels empowered and in charge of their own decisions is a happier patient, engages fully in their care, and usually has a quicker recovery time. Isn’t that what we’re all seeking?

 

If you have an experience (your own, a family member, or a friend) with this issue please feel free to share. I’d also ask you to share any solutions you came up with or methods you feel might help others in similar circumstances. Thank you for reading my blog!

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