What about alcohol use?

In tackling the topic of alcohol use and dementia, I am going to begin with a “myth-buster” statement based on the landmark study conducted in England and published in The Lancet in August, 2018, which concluded that there is “no safe level of alcohol consumption.” The pervasive belief that alcohol use in moderation is not harmful, and can even have health benefits. is, bluntly stated, alcohol user and alcohol industry propaganda.

That being said, we drink and we are going to continue to drink, and in the world of dementia care we must face and cope with the fact that our loved one living with dementia may have had a lifetime of alcohol use. How does this affect our standards and practices of care?

Dementia is not likely to cause a person to drink less, for two reasons. First, dementia strips them of inhibitions and self-control, and they will continue to want to practice the things they enjoy. Second, they will lose their sense of time, and if they were a person who paced themselves and had a couple of drinks over a period of hours, they will no longer know what “hours” are, so they will no longer remember or care when they had their last drink.

Drinking, like any habitual behavior, becomes a part of our “muscle memory;” part of our “emotional imprint.” We often do it without thinking. We just “feel” like it is time for a drink. Our loved ones with dementia have even less capability for rational thinking, and are driven by their feelings or “needs.” If alcohol has been one of those needs, they will continue to need it.
The fact that a person with dementia is driven by their muscle memory can be a positive force in the management of their care. Their taste buds also have changed, and they may no longer savor the alcohol they have always enjoyed.

How do we make this work for us? While managing a dementia care community, I had great success with enjoying a little wine before dinner with some of my residents. What they didn’t know or seem to care about was that their “wine” was cranberry juice, which, I might add, is beneficial in combatting urinary tract infections. They sipped their “wine,” relaxed, smiled, became more verbal, and even sometimes appeared to get a little “buzz” on! If I had tried to refuse these residents their evening wine ritual, I’m sure I would have had some serious problems on my hands!

I know of a woman who promised her husband from the outset of their relationship that she would never interfere in his love of beer. Later, after he contracted dementia, she stood by that promise. She provided him as much non-alcoholic beer as he wanted, and never had to deal with the troublesome combination of dementia and inebriation.

He didn’t care! It was still beer to him, probably because it fulfilled the needs of his muscle memory. He could hold the cold can, pop the top, hear the familiar sound, and then bring the can to his lips. Again, think what a problem it would have been if his wife had initiated the “Battle of the Beer” every time he wanted to drink.

So, our discussion of dementia and alcohol has evolved into reinforcement of what I consider one of the cardinal rules of dementia care. “Don’t remove; substitute!” It’s a sensible and compassionate way for both of us to fulfill our needs, and . . . as you know . . . we all deserve the best!

Until next time remember: “We all deserve the Best”
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