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• W2043228908 abstract "SALT LAKE CITY — The veterans were gung ho. Their objective: a better night's sleep. Victory was achievable, the old soldiers living in the Atlanta Veteran's Affairs Medical Center told medical director Kim House, MD, CMD. They just needed the right ammunition: a couple of beers, a shot, or some wine before bedtime. “It was not standard VA policy to do that,” said Dr. House as she presented a poster at AMDA's Annual Symposium. In fact, signs throughout the facility reminded residents and staff that “consumption of alcohol on federal property is a felony,” she said. But at the group's urging, Dr. House sought and secured permission to explore the possibility of alcohol in the facility—and not for medicinal purposes only. First, Dr. House and her colleague, Dr. Marzena Slater of Emory University, Atlanta, surveyed the residents on their sleep and their attitudes about alcohol “as an intervention for sleep and/or as a socializing option in the nursing home.” Of 80 residents interviewed, 51% reported problems falling asleep, staying asleep, or both. Nearly all those residents were receiving nightly medications for sleep, yet only 38% of that group found the medications effective. A full 90% of residents experiencing sleep problems were taking medications that may interfere with sleep, Dr. House and Dr. Slater found. About half the residents said they wanted a drink either at mealtime or bedtime, with beer and wine being the overwhelming choices. Several other sleep aids were endorsed as strongly as alcohol: warm milk, a nighttime snack, more sleep medication, gentle music, and flexible bedtimes. With the results in hand and an eye to the VA's ongoing initiative for culture change in its nursing homes, Dr. House pursued and achieved relaxation of the no-alcohol policy. For the past 6 months, she said, any resident has been free to receive beer, wine, or spirits—two servings at most—in the evening. “For the ones who want it, it's been a real quality of life change,” said Dr. House. During her poster presentation, she offered unpublished results since the taps opened. “We're actually finding fewer falls, more weight gain, less weight loss. The hospice patients are gaining weight, and a lot of them are coming off the antidepressants,” Dr. House said, adding that even some demented patients have improved their behavior. Residents also are reporting that the new policy works: They're getting to sleep easier. “This has resulted in a change so that about half of our residents get a drink every night, and we've been able to cut our pharmacotherapy [for sleep] by about half in those residents,” said Dr. House. She said that eight residents have stopped taking antidepressants since they began taking their drinks privately in their rooms or participating in informal happy hours. Dr. House described the scene when handfuls of residents sometimes gather for their evening drinks and socialize. “Guys are sitting there in their recliner chairs prior to getting into bed,” she said. Concerns of some personnel haven't materialized. “It really surprised a lot of the VA administrators [who had said], ‘Somebody's going to drink a beer, stand up, fall, and the family will sue,’” she said. And alcoholism issues haven't emerged. Even residents with dependence histories have been satisfied with one or two drinks a day. Facility personnel must dispense each “prescribed beverage” through the regular pharmaceutical order system, said Ted Johnson, MD, CMD, manager of geriatrics and extended care at the medical center. He has supported Dr. House's initiative and seen positive results from it, he said, but he called it “a work in progress.” Issues of potential alcohol abuse and liability remain, said Dr. Johnson. And when the program was proposed, some residents not only didn't want alcohol themselves but also didn't want others in their home to imbibe. That issue was handled by the center's resident council, which endorsed the ongoing experiment. Dr. Johnson added that Dr. House's work is being considered by the VA for wider adoption as part of the ongoing culture change for VA nursing homes, now called community living centers. Keith Haglund is publication editor of CARING FOR THE AGES." @default.
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• W2043228908 title "Nightly Nip Tucks Residents in for Better Sleep" @default.
• W2043228908 doi "https://doi.org/10.1016/s1526-4114(08)60179-1" @default.
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