In a new study in the January issue of JAMDA, researchers found that nearly half (43.9 percent) of people aged 65 and older in the United States consume alcohol, and given that it is not unusual for many individuals to want to continue drinking in some capacity after they enter a nursing home, there are questions on how providers handle this issue.

But how nursing centers do this can become complicated with the many potentially conflicting considerations that come into play in this setting, according to the study, which suggests that alcohol policies in nursing homes should incorporate elements of public health, human rights, and legal frameworks.

The authors of “Determinants for the Use of Alcohol in Long-Term Care Settings: A Comparative Analysis of Personal Choice, Public Health Advice, and the Law,” said there are many potential dilemmas involving alcohol consumption that make total prohibition both unrealistic and difficult to enforce.

Prohibition also can lead to other problems. For instance, some people may pressure staff to provide them with spirits. At the same time, nursing homes can’t allow unlimited alcohol consumption.

“A more nuanced approach is required that balances the older person’s right to exercise choice with the safety of other residents and nursing home staff,” the authors said.

Three frameworks are useful for analyzing the risks involved in a resident’s choice to drink alcohol:

• The public health framework promotes the elimination of risk, as it removes the possibility of health-related harm and improves population health, which is perceived to be for the public good. Deciding about alcohol consumption under this framework requires consideration of individual risks and benefits associated with consuming alcoholic beverages.

• The human rights framework considers the social and psychological harm experienced by the older person when something important or pleasurable—such as the choice to consume alcohol—is removed, including social isolation, loss of culture, and the frustration at loss of control.

• The legal framework involves legal mechanisms in the form of legislation, regulations, and common law, which govern a resident’s decision to consume alcohol. These include regulations outlining residents’ rights. The framework also addresses decision-making capacity; that is, the resident’s cognitive ability to make informed decisions about alcohol consumption.

“As the global population continues to age, the need for robust, comprehensive, and transparent decision-making policies surrounding alcohol consumption in nursing homes will become increasingly urgent,” researchers said.

“A holistic approach must be taken to ensure the complexities and controversies surrounding nursing home alcohol consumption are adequately addressed. This is best achieved through consideration of a public health, legal, and human rights framework.”

The study was conducted by researchers at Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia. Click here for more information on the findings.