geriatrics
History Taking in the Older Adult
Alcohol, Smoking, and Recreational Drug Use History
Patients who smoke tobacco should be counseled to stop and, if they continue, not to smoke in bed because older adults are more likely to fall asleep while doing so. Patients who use Vaping should be warned about the risks of Patients who use recreational drugs (eg, opioids, alcohol, marijuana,caffeine, hallucinogens) should be counseled about risk of addiction and possible interactions with prescription and other drugs. Patients should be checked for signs of Alcohol Use Disorder and Rehabilitation , which are underdiagnosed in older adults. Such signs include confusion, anger, hostility, alcohol odor on the breath, impaired balance and gait, tremors, peripheral neuropathy, and nutritional deficiencies. Screening questionnaires and questions about quantity and frequency of alcohol consumption can help. The Short Michigan Alcohol Screening Test-Geriatric Version (or SMAST-G) is a 10-question test designed for people 65 and older (seeScreening for Alcohol Use and Misuse in Older Adults). It is usually preferred to other screening questionnaires (eg, CAGE, AUDIT) that were not designed for older adults. Two or more “yes” responses suggest the possibility of an alcohol use disorder. When talking with others, do you ever underestimate how much you drink? After a few drinks, have you sometimes not eaten or been able to skip a meal because you didn’t feel hungry? Does having a few drinks help decrease your shakiness or tremors? Does alcohol sometimes make it hard for you to remember parts of the day or night? Do you usually take a drink to relax or calm your nerves? Do you drink to take your mind off your problems? Have you ever increased your drinking after experiencing a loss in your life? Has a doctor or nurse ever said they were worried or concerned about your drinking? Have you ever made rules to manage your drinking? When you feel lonely, does having a drink help? 