CONTENTS

Table of Contents
Introduction

1. Overview
2. Recognizing Alcohol Misuse and Abuse in Older Adults
3. Alcohol and Aging
4. Diagnosing Alcohol Problems in Older Adults
5. Recognizing Other Forms of Substance Abuse
6. Prevention and Early Intervention Strategies
7. Treatment
8. Outcomes and Cost Issues in Alcohol Treatment for Older Adults
9. Legal and Ethical Issues

Supplements
Resources

At Any Age, It Does Matter:
Substance Abuse and Older Adults (for Professionals)

Screening Instruments

Many instruments are available for screening. Screening questions can be asked through an in-person interview, a written questionnaire, a computerized questionnaire, or a telephone interview. Any positive responses should lead to further questions about consequences. Alcohol screening in clinical practice should be consistent with other screening procedures already in place.

In some settings, screening instruments are given as self-report questionnaires, with instructions for the patient to discuss the meaning of the results with his or her health care provider. Not all patients can see or read well enough to complete questionnaires. These factors need to be remembered when asking older adults to report on their drinking behaviors.

CAGE

The CAGE Questionnaire³⁶ and the Michigan Alcoholism Screening Test—Geriatric Version (MAST-G)³⁷ are two well-known screening instruments that have been validated for use with older adults. The CAGE is one of the most widely used alcohol screens. It consists of four questions, can be self-administered even by those with low reading skills, and can be modified to screen for use of other drugs.

The CAGE can be administered formally or informally as part of the intake process or when alcohol problems are suspected. Positive responses on the CAGE are for lifetime problems, not current ones. Before administering the CAGE or any other screen, it is important to ascertain that the person does currently drink alcohol and that positive responses relate to problems experienced recently, usually within the last year.

Although two or more positive responses are considered indicative of an alcohol problem, a positive response to any one of the questions should prompt further exploration among older adults. The CAGE is most effective in identifying more serious problem drinkers, including those with abuse and dependence. It is less effective for women problem drinkers than their male counterparts.

MAST-G

The MAST-G was developed by the University of Michigan Alcohol Research Center specifically for older adults. It was designed to address the problem of existing screening instruments in identifying alcohol problems among elderly individuals. The MAST-G has high sensitivity and specificity among older adults recruited from a wide range of settings, including primary care clinics, nursing homes, and older adult congregate housing locations.

The MAST-G has 24 questions and can be administered as part of the intake process when alcohol problems are suspected. A response of "yes" to six or more questions indicates a need for followup. The short form of the MAST-G can be used when time does not permit use of the MAST-G.

AUDIT

Although the Alcohol Use Disorders Identification Test (AUDIT)³⁸ has not been evaluated for use with older adults, it has been validated cross-culturally. Because there are few culturally sensitive screening instruments, the AUDIT may prove useful for identifying alcohol problems among older members of ethnic minority groups. Laboratory tests are generally used only to supplement screening tests.^39,40

Other Methods

In addition, instruments are available for determining alcohol quantity and frequency. General questions can be used to screen for alcohol use. More specific questions provide greater detail about drinking. These questions provide greater specificity about drinking and are not prone to underreporting errors when patients have to report their average consumption over time. These questions can be used to track a patient’s alcohol use. The Health Screening Survey includes such questions.