Throughout this fall semester, my Community Health clinical placement at the Laboure Center in South Boston has given me a new perspective on nursing care. It was the first time where I was able to see patients receive care beyond a hospital setting. Instead of having patients follow a diligent schedule of medication regimens, tests and surgeries; everything had to be done according to the patients’ schedules when they were at home. With this experience, I was able to see the challenges patients and nurses face while trying to meet the long-term goals of patient care and how nurses must accommodate their care given patients’ willingness to follow the plan set out for them as well as their financial constraints.

Being in the home setting, I realized that there were many issues patients faced and while I saw such things as hoarding, home safety and poor diabetes management what I found interesting was the problem of substance abuse in the elderly population. This hidden epidemic is a growing problem due to the challenges the individual, the family and the healthcare provider have in identifying the problem. The substance abuser may be in denial, have the belief that substances provide anticipatory relief or be too ashamed or guilty to address the issue with friends, families and/or healthcare providers. On one of my home visits, I distinctly remember one patient we saw who would refuse to give up smoking even though she had chronic obstructive pulmonary disease (COPD) and was on oxygen simply. Even when the nurse explained how the smoking was making her COPD worse and the danger of an explosive fire caused by smoking with the oxygen, she would still refuse to quit and stated that “it was one of the few pleasures she had left in life” and that she wasn’t going to stop for anyone.

Family and friends may feel uncomfortable discussing the topic, believing it shows disrespect to ones’ elders so they rationalize the problem (how much harm can a few drinks do?) and allow the person to continue the substance abuse. The healthcare provider may fail to recognize that certain medical conditions are a result of substance abuse or may be embarrassed to even screen for substance abuse in the elderly since it is considered a young person’s vice. Due to the numerous complications that may arise from continued substance abuse (heart attacks, stroke, mental status changes, lung cancer, etc.), it is essential that it is detected early on so that the patient are able to receive the treatment they need. That is why I chose to develop a screening tool for my community health project that was specific to the substance being used (alcohol, nicotine and prescription pills) and to the geriatric population.

After extensive research on various screening tools and community resources available to patients with substance abuse problems, I then developed three brochures for each substance abuse and met with my mentor to see how these brochures can be utilized in the community. With her help, we worked together to try and make it part of the admission assessment through the Laboure Center’s Visiting Nurses Services and at the Boston University Geriatrics. With the utilization of these tools we hope to prevent the serious health complications patients with substance abuse can develop.

To view Nguyet’s presentation on her Community Health Project, please access the following link: KILN Community Health Presentation – Nguyet Chau