Addiction in older adults — structured clinical viva

Reject the junior plan. Post-operative day 2–3 confusion with autonomic arousal after unrecorded heavy alcohol use is classic alcohol withdrawal until proven otherwise — not "UTI only." High-dose haloperidol alone without GABA-A cover risks worsening the picture; ageist refusal of detox is unsafe.[1][3]

Immediate management. ABC, concurrent delirium work-up (infection, electrolytes, hypoxia, pain, constipation, medications), benzodiazepine protocol with geriatric sedation and falls monitoring, parenteral thiamine, magnesium/electrolytes, close nursing, and collateral alcohol/sedative history (including pre-admission BZD that may have been omitted).[1][2]

Later care. Screen systematically (AUDIT-C/SMAST-G culture), brief intervention/SBIRT (BRITE logic), dual diagnosis for depression and suicide risk, and after detox consider naltrexone 50 mg daily if opioid-free with monitoring (Oslin older-adult adjunct evidence).[6][4][5]