My post last month, "Is It Dementia or Delirium?" has kept nagging at me, and I've finally figured out why. There's something else that needs to be considered, when evaluating an elder who is confused or even delirious while in the hospital. We need to consider alcohol.

The first elder who I officially cared for was my next-door neighbor, Joe. Joe was totally deaf from Ménière's disease. He was in his 80s and alcohol had been a large part of his life since Prohibition, when he'd carry a hip flask of moonshine. It wasn't news to me that Joe was alcoholic. When I became his default caregiver, he was in his mid-eighties, and had no desire to change. It was a part of who he was, and we both knew it. We also both knew that, in some way, alcohol would likely have a part in what killed him.

Joe fell often, and much of it was after a number of drinks. One evening he was barbecuing in his garage. I looked out my kitchen window and saw him lying on the ground. I ran out to help, and found that he was injured, so I had to call an ambulance. They found, at the hospital, that he'd dislocated his shoulder. They had to give him Valium and some other drugs so they could manipulate the shoulder back into the socket. That done, they were going to send him home, where he would be alone. I had children who also needed me, so I couldn't stay with him. I told them that.

Joe, who had a body full of alcohol and drugs and thought I was his long dead wife, but they wanted to send him home. He was confused, frightened, delirious. But they wanted to send him home. When I pleaded with the hospital staff to have him stay overnight, they said they weren't sure that Medicare would pay for his overnight stay, so they were going to send him home.

I knew this was crazy. I also knew Joe's family wouldn't go broke if they had to pay for a night in the hospital, so I called his son in New Jersey and told him what I thought. He backed me up, I told the hospital to keep Joe. I told them that if Medicare didn't pay, the family would. Never, in this circus, did anyone question the fact that Joe smelled like a bottle of vodka. That he wasn't just full of the Valium and other drugs they had administered - he was also full of alcohol, as well.

A year later, one of Joe's falls resulted in a broken hip. He, of course, had been drinking, because he'd always "been drinking." That's what he did! We rode the ambulance together again, but this time I had to leave him. They needed to do surgery.

I went to the hospital to see him the next day, and he was in mental and physical agony. He told me about his "dreams." He was frightened and shaking. I knew much of this was likely caused by alcohol withdrawal. The doctors brushed me off. Was his alcoholism such a "crime" that they couldn't have sympathy?

Joe spent a terrible week in the hospital, with no treatment aimed at his withdrawal. After a week, he was to be discharge, and I was able to get him into a nearby nursing home. He was still suffering from withdrawal. He had frightening dreams, and wandered in and out of reality. You don't get over a lifetime of alcohol dependence in a week.