Primary care physicians can anticipate encountering more elderly patients with alcohol problems since this population is increasing and the prevalence of alcohol problems has been stable. Brief screening tools, originally developed and validated among younger adults, may not be appropriate in the elderly. Therefore, specific validation studies and the development of elderly specific instruments have been reported. The specific goals of this report are to (1) review available screening tools for alcohol problems, (2) summarize elderly focused studies, and (3) provide recommendations for use in primary care. Using a variety of standards, the CAGE (Cut down, Annoyed, Guilty, and .Eye opener) is the most consistent brief screen, but its threshold may need to be adjusted in the elderly. The Michigan Alcoholism Screening Test-Geriatric Version includes elderly-specific consequences, but its length may hinder routine use even in shortened form. Finally, the Alcohol Use Disorders Identification Test, although less sensitive than the CAGE, can also capture problem drinkers. Efforts are needed to include elderly-specific consequences and meaningful consumption thresholds in a brief, easily applied screen.
Get full access to this article
View all access options for this article.
References
1.
1. Taeuber C.Sixty-five plus in America. In: Current population reports. Series P-23, no. 178. Washington, DC: US Government Printing Office, 1992.
2.
2. US Department of Health and Human Services.A profile of older Americans: 1994. Washington, DC: American Association of Retired Persons and Administration on Aging, 1994.
3.
3. Atkinson RM. Aging and alcohol use disorders: diagnostic issues in the elderly. Int Psychogeriatr1990; 2:55–72.
4.
4. Grant BF. Alcohol consumption, alcohol abuse and alcohol dependence. The United States as an example. Addiction1994; 89:1357–1365.
5.
5. Williams GD, DeBakey SF. Changes in levels of alcohol consumption: United States, 1983–1988. Br J Addict1992; 87: 643–648.
6.
6. Adams WL, Magruder-Habib K, Trued S, et al. Alcohol abuse in elderly emergency department patients. J Am Geriatric Soc1992; 40:1236–1240.
7.
7. Buchsbaum DG, Buchanan RG, Lawton MJ, et al. Alcohol consumption patterns in a primary care population. Alcohol1991; 26:215–220.
8.
8. Curtis JR, Geller G, Stokes EJ, et al. Characteristics, diagnosis, and treatment of alcoholism in elderly patients. J Am Geriatric Soc1989; 37:310–316.
9.
9. Liberto JG, Oslin DW, Ruskin PE. Alcoholism in older persons: a review of the literature. Hosp Community Psychiatry1992; 43:975–984.
10.
10. Magruder-Habib K, Saltz CC, Barron PM. Age-related patterns of alcoholism among veterans in ambulatory care. Hosp Community Psychiatry1986; 37:1251–1255.
11.
11. Mangion DM, Platt JS, Syam V.Alcohol and acute medical admission of elderly people. Age Aging1992; 21:362–367.
12.
12. Schuckit MA, Miller PL. Alcoholism in elderly men: a survey of a general medical ward. Ann N Y Acad Sci1975; 275: 558–571.
13.
13. Simon A, Epstein LJ, Reynolds L.Alcoholism in the geriatric mentally ill. Geriatrics1968; 23:125–131.
14.
14. Gaitz CM, Baer PE. Characteristics of elderly persons with alcoholism. Arch Gen Psychiatry1971; 24:372–378.
15.
15. Tabisz E, Badger M, Meatherall R, et al. Identification of chemical abuse in the elderly admitted to emergency rooms. Clin Gerontol1991; 11: 27.
16.
16. Adams WL, Yuan Z, Barboriak JJ, et al. Alcohol-related hospitalizations of elderly people. Prevalence and geographic variation in the United States. JAMA1993; 270:1222–1225 [published erratum appears in JAMA 1993; 270:2055].
17.
17. Council on Scientific Affairs, American Medical Association.Council report: alcoholism in the elderly. JAMA1996; 275: 797–801.
18.
18. US Preventive Services Task Force.Screening for problem drinking. Guide to clinical preventive services.2nd Ed.Baltimore: Williams and Wilkins, 1996: 567–582.
19.
19. McInnes E, Powell J.Drug and alcohol referrals: are elderly substance abuse diagnoses and referrals being missed?BMJ1994; 308:444–446.
20.
20. Fink A, Hays RO, Moore AA, et al. Alcohol related problems in older persons: determinants, consequences, and screening. Arch Intern Med1996; 156:1150–1156.
21.
21. Polich JM. The validity of self reports in alcoholism research. Addict Behav1982; 7:123–132.
22.
22. Hartford JT, Samorajski T.Alcoholism in the geriatric population. J Am Geriatr Soc1981; 30:18–24.
23.
23. Graham K.Identifying and measuring alcohol abuse among the elderly: serious problems with existing instrumentation. J Stud Alcohol1986; 47:322–326.
24.
24. Jones TV, Lindsey BA, Yount P, et al. Alcoholism screening questionnaires: are they valid in elderly medical outpatients?J Gen Intern Med1993; 8:674–678.
25.
25. Buchsbaum DG, Buchanan RG, Welsh J, et al. Screening for drinking disorders in the elderly using the CAGE questionnaire. J Am Geriatr Soc1992; 40:662–665.
26.
26. Morton JL, Jones TV, Manganaro MA. Performance of alcoholism screening questionnaires in elderly veterans. Am J Med1996; 101:153–159.
27.
27. Joseph CL, Ganzini L, Atkinson RM. Screening for alcohol use disorders in the nursing home. J Am Geriatr Soc1995; 43: 368–373.
28.
28. Fulop G, Reinhardt J, Strain JJ, et al. Identification of alcoholism and depression in a geriatric medicine outpatient clinic. J Am Geriatr Soc1993; 41:737–741.
29.
29. Luttrell S, Watkin V, Livingston G, et al. Screening for alcohol misuse in older people. Int J Geriatr Psychiatry1997; 12: 1151–1154.
30.
30. Selzer ML. The Michigan Alcoholism Screening Test: the quest for a new diagnostic instrument. Am J Psychiatry1971; 127:1653–1658.
31.
31. Willenbring ML, Christensen KJ, Spring WD, Rasmussen R.Alcoholism screening in the elderly. J Am Geriatr Soc1987; 35:864–869.
32.
32. Yersin B, Trisconi Y, Paccaud F, et al. Accuracy of the Michigan Alcoholism Screening Test: screening of alcoholism in patients of a medical department. Arch Intern Med1989; 149: 2071–2075.
33.
33. Brady Moran M, Naughton BJ, Hughes SL. Screening elderly veterans for alcoholism. J Gen Intern Med1990; 5:361–364.
34.
34. Blow FC, Brower KJ, Schulenberg JE, et al. The Michigan Alcoholism Screening Test-Geriatric Version (MAST-G): a new elderly specific screening instrument. Alcohol Clin Exp Res1992; 16: 372.
35.
35. Blow FC, Gillespie BW, Barry KL, et al. Brief screening for alcohol problems in elderly population using the Short Michigan Alcoholism Screening Test-Geriatric Version (SMAST-G). 1998;20–25.
36.
36. American Psychiatric Association.Diagnostic and statistical manual of mental disorders.3rd Ed., rev.Washington, DC: APA, 1987.
37.
37. American Psychiatric Association.Diagnostic and statistical manual of mental disorders.4th Ed.Washington, DC: APA, 1994.
38.
38. Miller NS, Belkin BM, Gold MS. Alcohol and drug dependence among the elderly: epidemiologic, diagnosis and treatment. Compr Psychiatry1991; 32: 153.
39.
39. Rinaldi RC, Steindler EM, Wilford BB, Goodwin D.Clarification and standardization of substance abuse terminology. JAMA1988; 259:555–557.
40.
40. Sanchez-Craig M.How much is too much? Estimates of hazardous drinking based on clients' self-reports. Br J Addiction1986; 81:251–256.
41.
41. Sanchez-Craig M, Wilkinson A, Davila R.Empirically based guidelines for moderate drinking: 1-year results from three studies with problem drinkers. Am J Public Health1995; 85:823–828.
42.
42. Saunders JB, Aasland OG, Babor TF, et al. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction1993; 88:791–804.
43.
43. National Institute on Alcohol Abuse and Alcoholism. The physicians' guide to helping patients with alcohol problems. NIH publication no. 95-3769,1995.
44.
44. Chermack ST, Blow FC, Hill EM, Mudd SA. The relationship between alcohol symptoms and consumption among older drinkers. Alcohol Clin Exp Res1996; 20:1153–1158.
45.
45. Poikolainen K.Epidemiologic assessment of population risks and benefits of alcohol use. Alcohol Alcohol1991; 1(Suppl): 27–34.
46.
46. Doll R, Peto R, Hall E, et al. Mortality in relation to consumption of alcohol: 13 years' observations on male British doctors. BMJ1994; 309:911–918.
47.
47. Klatsky AL, Armstrong MA, Friedman GD. Red wine, white wine, liquor, beer, and risk for coronary artery disease hospitalization. Am J Cardiol1997; 80:416–420.
48.
48. Kristenson H, Ohlin H, Hulten-Nosslin MB, et al. Identification and intervention of heavy drinking in middle-aged men: results and follow-up of 24-60 months of long-term study with randomized controls. Alcohol Clin Exp Res1983; 7:203–209.
49.
49. Fleming MF, Lawton-Barry K, Manwell LB, et al. Brief physician advise for problem alcohol drinkers: a randomized controlled trial in community-based primary care practices. JAMA1997; 277:1039–1045.
50.
50. Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA1984; 252:1905–1907.
51.
51. Buchsbaum DG, Buchanan RG, Centor RM, et al. Screening for alcohol abuse using CAGE scores and likelihood ratios. Ann Intern Med1991; 115:774–777.
52.
52. Bush B, Shaw S, Cleary P, et al. Screening for alcohol abuse using the CAGE questionnaire. Am J Med1987; 82:231–235.
53.
53. King M.At risk drinking among general practice attendees: validation of the CAGE questionnaire. Psychol Med1986; 16:213–217.
54.
54. Bohn MJ, Babor TF, Kranzler HR. The Alcohol Use Disorders Identification Test (AUDIT): validation of a screening instrument for use in medical settings. J Stud Alcohol1995; 56:423–432.
55.
55. Babor TF, de la Fuente JR, Saunders J, Grant M. AUDIT. The Alcohol Use Disorders Identification Test. Guidelines for use in primary health care. Doc. #WHO/MNH/DAT/89.4. Geneva: WHO, 1989.
56.
56. Cyr MG, Wartman SA. The effectiveness of routine screening questions in the detection of alcoholism. JAMA1988; 259: 41–44.
57.
57. Gomberg ESL. Drugs, alcohol and aging. In: Kozlowski LT, Annis HM, Cappel FB, et al, eds. Research advances in alcohol and drug problems. Vol. 10. New York: Plenum, 1990.
58.
58. Bush K, Kivlahan DR, McDonell MB, et al. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Arch Intern Med1998; 158:1789–1795.
59.
59. Gordon AJ, Maisto SA, McNeil M, et al. Comparisons of abbreviated instruments to detect hazardous drinking in a large primary care sample. Unpublished data.
60.
60. Rosman AS, Lieber CS. An overview of current and emerging markers of alcoholism. In: Litten R, Allen J, Eds. Measuring alcohol consumption. Totowa, NJ: Humana Press, 1992: 99–134.
61.
61. Sorvajarvi K, Blake JE, Israel Y, Niemela O.Sensitivity and specificity of carbohydrate-deficient transferrin as a marker of alcohol abuse are significantly influenced by alterations in serum transferrin: comparison of two methods. Alcohol Clin Exp Res1996; 20:449–454.
