Explain late-life alcohol and sleeping-tablet plan to patient and son — CASC communication station

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar on the old-age liaison service. [1]

Candidate instructions. Explain in plain language that alcohol and long-term sleeping tablets can cause serious harm in later life; address the son's worry that suggesting change means calling Dad an "alcoholic"; outline why stopping both suddenly in hospital is unsafe; describe a supervised plan including vitamins for brain protection, a slow temazepam reduction, alcohol supports and optional medication such as naltrexone; discuss mood and safety; check understanding. [1][2][4]

Candidate scenario

Your patient has increased from social drinking to daily heavy wine since retirement, uses temazepam 20 mg orally at night for many years, presented after a fall with early withdrawal when both were omitted, and scores positive on age-attuned alcohol screening. MoCA is mildly reduced. He fears "being cut off" from the only things that help him sleep. The son fears stigma and wants reassurance that reducing tablets will not cause a seizure if done properly. [1][2]

Marking domains

• Empathy, non-stigmatising language, shared agenda with patient and son
• Accurate plain-language explanation of late-life alcohol and sedative harm (falls, confusion, dependence)
• Clear acute safety message: do not stop chronic benzodiazepines abruptly; thiamine/vitamin and withdrawal monitoring matter
• Practical long-term plan: slow taper principles, sleep alternatives, alcohol psychosocial supports and optional anti-craving medicine
• Mood/suicide safety-netting and follow-up
• Checks understanding / teach-back [2][3][5]