As many people have learnt to their cost, the effects of acute alcohol consumption can be both seen and felt. The elderly are no different in this, though their tolerance to alcohol may be diminished. Initial feelings of well-being give way to increasing loss of social inhibitions, unsteadiness, slurred speech, difficulty concentrating, then to aggressive tendencies, nausea and vomiting, and finally to falls and unconsciousness. All of the above can occur even faster if alcohol is mixed with medication. Thus alcohol abuse should be considered in all cases of acute confusional states as well as chronic ones.

Some elderly people have carried their alcohol abuse along with them for years. These are probably in a minority, for the effects of severe alcohol abuse are not compatible with a long life. However these chronic abusers may show the effects of the alcohol on every body organ. The liver may be cirrhotic (severely scarred and fibrotic) and after heavy drinking bouts they may become yellow (due to a form of hepatitis – inflammation of the liver). General nutrition is often poor and the person looks malnourished, being thin, with a poor complexion, bad teeth and skin, a tendency to bruise easily and prone to chest infections, etc. This poor nutrition can be general or more specific if vitamins are missing. Alcoholics can be deficient in the vitamin thiamine and then present fairly acutely with falls, due to an inability to walk properly (ataxia – not the acute effects of alcohol), eye problems and an acute confusional state (Korsakoff’s psychosis), the whole brain condition being called Wernicke’s encephalopathy. The response to being given thiamine is usually dramatic.

If the supply of alcohol is suddenly withdrawn from a chronic abuser (admission to hospital or old people’s home) then it can produce the DT’s (delirium tremens). This is a very dangerous condition, with a craving for alcohol and then confusion, accompanied by hallucinations. It can be fatal, especially in the more frail elderly alcohol abuser. The long-term effects of alcohol on the brain are equally as bad. Alcohol is a well recognized cause of chronic confusion or dementia. The memory loss is accompanied by a deterioration of the personality. The emotional trauma to carers is very great indeed – having to cope with a dementing person made regularly worse by bouts of heavy drinking.

Some people only turn to alcohol in late life. It may be possible to find a precipitating cause such as bereavement, depression or a chronic painful medical condition. These people usually present with frequent falls or frequent bouts of confusion that disappear after 24 hours in hospital. They have not been drinking long enough for the physical signs to show and their bodies are not dependent on the alcohol so that they rarely get the DTs. Alcohol may be smelt on the breath or found in the blood in someone who is unconscious. More commonly, empty bottles are found in the bedside cabinet during an assessment visit to an old lady who is falling over a lot, and someone has requested her admission to an institution.

Long-term dependence on alcohol is as hard to treat in elderly people as it is in the younger age groups. A commitment to stop and keep off alcohol under difficult circumstances has to be present. There are many organizations that can help but few centers for rehabilitation of alcohol abusers will consider elderly people. The late onset drinker has a better prognosis, for it may be possible to identify the cause of the drinking and treat it. There are a few people who appear to develop a drinking habit detrimental to their health after they have started to become confused with a dementing illness such as Alzheimer’s disease, and these few can be particularly hard to help.

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Another eye care professional using refractive corrections with lenses, the optometrist (pronounce (op/TOM/e/trist), has an O.D. degree which represents him or   her as a doctor of optometry.   The O.D. provides vita primary health care services.   For   instance,   the optometrist examines,   diagnoses,   and   prescribes   specific   treatment for conditions of the vision system.

Optometrists examine eyes   and   related structures   to determine the presence of vision   problems, diseases or other   abnormalities.   They   utilize   drugs   for   diagnostic purposes   when permitted   by state   laws (which are changing throughout   the   country).   By   thoroughly   evaluating   the internal and external structure  of the  eyes,  optometrists  can detect systemic  and  eye  diseases  that  require  referral of thee patient to other health care practitioners.

The  optometrist   treats   by  prescribing  and  adapting spectacle  lenses,  contact  lenses,  or  other  optical  aids  and uses  visual  training/vision  therapy  to  preserve  or  restore maximum efficiency of vision.

Education  of  the  optometrist   includes   two  to  four   years of college pre pre-optometric   training  and   four  additional   years of  specialized   professional   training  at  an   accredited   college of optometry.

In contrast to the other two eye care professionals, the optician (pronounced OP/ti/cian) is not degreed as a doctor. An optician is the technical part of the lens-servicing team. He or she may also be known as a dispensing optician or an ophthalmic dispenser. The optician could be both or either of these designated types of specialists. The dispensing optician makes and fits eyeglasses and/or contact lenses. He or she designs, verifies, and delivers lenses, frames, and other specially fabricated optical devices upon prescription to the intended wearer.

The ophthalmic dispenser both tests people for eyeglasses and also makes and fits them. The ophthalmic dispenser’s functions include, but are not limited to, prescription analysis and interpretation, the taking of measurements to determine the size, shape, and specifications of the lenses, frames, contact lenses, or lens forms best suited to the wearer’s needs; the preparation and delivery of work orders to laboratory technicians engaged in grinding lenses and fabricating eyewear; the verification of the quality of finished ophthalmic products; the adjustment of lenses or frames to the intended wearer’s face or eyes; and the adjustment, replacement, repair and reproduction of previously prepared ophthalmic lenses, frames, or other specially fabricated ophthalmic devices.

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