Is it wrong to water down the alcohol my dad with Alzheimer's drinks?

16 answers | Last updated: Sep 27, 2016
Janey in milford asked...

My father is Stage 5 Alzheimer's and soon to be 78. He likes to have a cocktail each night before he has been having a cocktail before dinner. However, recently he has been having more than the usual 1 or 2. Or making them in the morning. We have watered down his whiskey. He has NOT noticed, by one of my sisters is opposed to this. any thought???


Expert Answers

Joanne Koenig Coste is a nationally recognized expert on Alzheimer's care and an outspoken advocate for patient and family care. She is the author of Learning to Speak Alzheimer's. Also, she currently is in private practice as an Alzheimer's family therapist. Ms. Koenig Coste also serves as President of Alzheimer Consulting Associates, implementing state-of-the-art Alzheimer care throughout the United States.

It may surprise you to hear that this is not an unusual question. Accolades to you for seeking ways to keep his alcohol consumption at a minimum. I am in complete accord with you about watering the whiskey and suggest you continue to do so while increasing the amount of water. Some caregivers have had great success by getting rid of the whiskey completely and replacing it with white grape or apple juice; others have replaced the stronger alcohol with a white wine/water mixture. Do chat with his doctor about your dad's consumption and pass his thoughts and recommendations on to your sister. Chances are she is feeling a sense of betraying his trust by watering his drinks and she needs to be reassured that these caregiving-decisions are what will keep him functioning at the best level for as long as possible - it is not about relationship, it is about the disease. The reason for your father's increased interest in cocktails is related to not remembering having already had a drink, nor being aware of the time of day at any given point during the day. Alcohol, Alzheimer's, depression or stress, and medications can be a harmful combination and need to be closely monitored. The side effects of increased alcoholic intake are quite different in a person with AD. Do take care of you and.......Cheers!


Community Answers

Gotedge answered...

Your father may be an alcoholic, but I understand what you are trying to accomplish. With stage 5 Alzheimer's he is not cognizant of what he is doing and to try to break an old habit would be disasterous. It is the old habits that connect him to this world and it is too late to lecture him on the problems alcohol can cause.

By watering his drinks, you are minimizing the effects of alcohol on his already diminished ability to live in reality but it allows him the dignity of one life choice as his capacity disappears. Sometimes a reduced harm is the greatest good.


Capt. foxie answered...

We have to remember that our loved one is not cognizant of yesterday let alone in the presence and a water-down cocktail at this point who care??? My mother is a smoker. I light her cigarette. That is what keeps her connected to the here and now. She can't have a lighter and has finally accepted that. She does say I wish I had it like before. But that saying does not come out everyday. I try to give her some quality of life as I would hope some one else would do for me if this dreaded disease would try to find a home in my brain. (I have put out a sign NO VACANCY) BUT with Az they seem to wiggle their way in with no regards... Let our loved ones enjoy what little they remember ;)


Bllondie answered...

I have to agree, let them live and enjoy what little they can remember at times. My dad was a beer drinker, and enjoyed every one! When the alz was stage 5 and up, I admit to adding a little water, he never complained, and felt he was still getting his tall cold one like he did 15 yrs before!


Daug-in-law answered...

My husband's grandfather used to dilute the drinks he'd mix for his wife, by carefully 'floating the alcohol' (1/2 ounce instead of 1 ounce) on top of the soft drink. First few sips taste like a strong drink. When she asked for her second customary drink, it only got a splash on top and sometimes he would rub some on his lips and give her a kiss on the lips while handing her the glass.


Geri hall answered...

With all due respect, people with AD do not suddenly become alcoholics after 78 years of relative sobriety. This man has been a moderate drinker (1-2 drinks per day) until stage 5 dementia.

At stage 5 he has no memory of how many drinks he has had and isn't able to stop the impulse to have his "usual drink." So he needs someone to provide structure and keep the drinks to his premorbid (pre-illness) number. In my practice these things are usually social events for the patient.

That said, alcohol is essentially a brain poison, slowly assisting the AD to progress. So watering the drinls -- especially if he doesn't notice -- is an intervention I use routinely with patients.

Also, with ANY alcohol consumption, in dementia the effect of the alcohol is greatly magnified. So moderating the "dose" is a good idea.

But in America so many people that age have had a drink or two after the day as a normal routine, telling the patient to give it up entirely may affect his quality of life dramatically.

In stage 5, the goal of care is to keep the persoin as content and comfortable as possible and in this situation, two watered slowly consumed drinks at the appointed hours, are okay.

Now, if Grandpa lives alone.......that is quite another story.

Geri R Hall, PhD, ARNP, GCNS, FAAN Advanced Practice Nurse Banner Alzheimer's Institute


Debgoldie answered...

No harm, no foul, especially if he hasn't noticed and has increased his amount of drinks.


Cela answered...

I personally do NOT think theres anything wrong with doing this. Especially if hes hitting the bottle in the morning....that sounds to me like the beginning of alcoholism. My dad died of cyhrossis of the liver...& i DID try, not watering the whiskey down, but i actually put pepper in his 5th. I was in my teens & hated to see my dad drink. Now, I'm sure your sister will say THATS DIFFERENT. I feel your pain...my mom is 96 & has Alzheimers. I know u know that Dimentia is a symptom of Alz. but Alz. is NOT a symptom of Dimentia. With that being said...i'd find out WHY hes drinking in the morning... i'd guess its because hes having a hard time dealing with the dimentia. Try getting him busy in the morning or even having someone visit him a few times a week...a friend if possible. If not, & money isn't an issue, have a CNA come in & visit 3 times a week. I am a CNA & i've had a few cases where i'd go to dimentiad peoples home & help with a bath, if he doesn't need bath assistance, the aide can go for walks, do some range of motion exercises, or play some board games, read or even go shopping.
I've helped a lot of both men & women deal with dementia. Its very hard on the pride & emotions dealing with dementia or Alzheimers, not only on the person suffering but also on the family. I hope this helps. If you would like any further info, just let me know. Catcrazygal


Ca-claire answered...

For years, my parent's insisted that they had to drink decaf coffee. My spouse at the time drank only regular coffee. After asking them many times why their coffee had to be decaf, the answer was they liked the flavor better and if they drank regular, they would be up all night. Whenever they were at my home, the coffee was regular (my spouse always drank really good coffee). I would just tell them it was decaf. Sometimes, they would ask for a cup of coffee at bedtime. Not once did they ever mention that they had a hard time sleeping, for if they had, I would have switched to decaf when they visited (I have never drunk coffee). The mind is a very powerful thing.

The point of this is, get some apple cider to put in the whiskey bottle. Most seniors have lost most of their sense of taste, so the substitution won't even be noticed. If he notices, just say you couldn't find his regular brand so you purchased another one instead. No harm, no foul. My uncle was very high up in an oil company (EVP of PR). Had to entertain frequently. He always refilled the 'top shelf' bottles with cheap stuff, and no one ever complained. I caught him doing it one time the day before a party.


Daug-in-law answered...

He could be drinking in the morning for a number of reasons... Boredom is a major factor as is, the fact that he's not aware what time it is!!!


Awitta answered...

I have just one bit of important information to add to this discussion. I am a Certified Alcohol and Drug Counselor and have studied some Pharmacology. Was your father an alcoholic, needing to drink on a daily basis? Sometimes, we think that withdrawing the harmful substance is a good thing. In this case, and only if your father was alcohol dependent for much of his life and alcohol intake is terminated suddenly, he could go into fatal withdrawals! This usually takes the form of seizures, but he will also show other signs of withdrawal (high anxiety and agitation). Withdrawal can be mitigated with benzodiazapines, and Vitamin B12 shots also assist. On the other hand, if he continues drinking, the timing and amount of alcohol intake needs to be considered for interactions with medications, as well as long-term effects (are his liver enzymes normal?). Hope this helps; alcohol intake in the elderly population is a complex issue; these include psychological factors discussed in prior feedback to you. I also wanted you to be aware of the physiological factors to consider. With that said, I am not an M.D. or Pharmacist, I would discuss alcohol withdrawal (if it is a potential issue) with his doctor or pharmacist before heeding any advice in these columns.


Ca-claire answered...

Awitta brings up some good points on the withdrawal/physiological problems with watering down his alcohol. If you have been doing this for quite some time, you could slowly start watering the alcohol down more and more. If his favorite cocktail contains whiskey, watering it down with the apple cider will keep the color what he is accustomed to.

Make sure that his MD does know exactly how much your father is accustomed to drinking, and how his AD may be confusing him as to time of day/how many he is drinking.

Slowly watering down his whiskey will allow any sort of withdrawal symptoms to be small, and remember that some withdrawal symptoms may mimic AD symptoms as well.

Best wishes to you in this difficult situation!


Awitta answered...

Geri Hall,Ph.D. contributed very important points on this complex issue. Alzheimer's itself is a brain disease, and alcohol's effects (vascular and otherwise) certainly cannot be helping. Further, the effects on gait and balance are dangerous and increase a risk for a fall! I was concerned about complete abrupt withdrawal with a full fledged alcoholic. (Do his hands shake in the morning until he has had his first drink? Or is he simply consuming his drinks with dinner, with no obvious effects if he doesn't get his drink?) It appears that your father has been a moderate drinker, not an alcoholic. It appears that watering his drinks is a good idea, and that he is not likely to go into withdrawal.


Geri hall answered...

I really appreciate Awitta's response about the withdrawal but will add to his/her answer....

Benzodiazapines used in withdrawal of alcohol in young people are contraindicated in older adults due to their halflives and potential for rebound and paradoxical effects. In those with longer retnetion in the body (half life) we see enormouse quick accumilation in the body as additional doses are given. Thus, in our practice we decrease alcohol and water it very very slowly as the alcohol in minute amounts is better than the benzodiazepines (ativan/lorazepam; xaxax, restoril, valium, etc)

One last thing:

Claire wrote: Most seniors have lost most of their sense of taste, so the substitution won't even be noticed.

As a board certified gerontological specialist, seniors may have some alterations in taste with aging but most are able to taste quite nicely throughout the lifespan. With AD there is loss of sense of smell due to deterioration of the olfactory nerve. This occurs early in the disease. The sense of taste is based mostly on smell so the person with AD has to rely on the senses from the tongue: bitter, sour, salty, and sweet. So many benign foods such as meat and veggies taste sour of bitter and patients gravitate towards sweet food.

Respctfully

Geri

Geri R Hall, PhD, ARNP, GCNS-BC, FAAN Advanced Practice Nurse Banner Alzheimer's Institute


A fellow caregiver answered...

I really appreciate everyone's advice and comments. Thank you


A fellow caregiver answered...

My dad, who had vascular dementia, hadn't had a drink in many years-maybe a decade or more- kept asking for a drink- a beer or whisky. He was on meds and had enough mood problems so I couldn't give him an alcoholic drink. Anyway, becks makes a non-alcoholic beer drink that is pretty decent. I first gave it to him without the bottle but he didn't fall for it saying 'this is Not a beer.' Next time I tried I brought the bottle to him and poured the beer in front of him and he bought it! It was all about the packaging-He was like 'that was a real beer.' It solved at least one problem and made him happy!