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

Module 4: Diagnosing Alcohol Problems in Older Adults - Page 18 of 32

Substance Abuse Assessment Instruments

Assessment tools should be used to determine the presence and severity of a problem. These tools also help to identify how the problem has affected significant people in the older person’s life. An assessment interview should be comprehensive and identify immediate and long-range needs. It is important to explore all problems and issues, even if they do not seem related to substance abuse.

The best assessment instruments are sensitive to the needs of chemically dependent older persons and the differences between the effects of chemical dependency and the effects of aging and illnesses. Because gathering information can be difficult, it is best to use a variety of methods. This will ensure greater accuracy in defining the problem. The assessment should result in an individualized treatment or care plan.

The Index of Activities of Daily Living and Instrumental Activities of Daily Living Scale (developed by the American Geriatrics Society) are useful tools. Another instrument is the Multidimensional Functional Assessment Questionnaire developed by the Duke University Older Americans Resources and Services Program.

It often helps to interview members of the person's social network.

Another useful instrument is the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), a self-report questionnaire that measures health-related quality of life, including both ADLs and IADLs.45 Although this instrument is more comprehensive, it is also more difficult to use because of complex scoring of the various subscales. The SF-36 does provide, however, a comprehensive assessment of health and not just functional abilities. These instruments can be used by health care providers in a range of settings.

Structured Assessments

Although informed clinical judgment is essential for a sound assessment, validated substance abuse assessment instruments can provide a useful structured approach for many clinicians. They also provide a convenient checklist of items that should be consistently evaluated during the assessment.

In general, specialized assessment is conducted by treatment program personnel or specially trained health care providers. Structured assessment interviews "possess (at least potentially) the desired qualities of quantifiability, reliability, validity, standardization, and recordability."41

Two structured assessments with older adults are available: the Structured Clinical Interview for DSM-IV (SCID) and the Diagnostic Interview Schedule (DIS) for DSM-IV. These are commercially available products that may require special training for proper use. The SCID is a multimodule assessment that covers:

It takes a trained clinician approximately 30 minutes to administer the 35 SCID questions that probe for alcohol abuse or dependence.

The DIS is a highly structured interview that does not require clinical judgment and can be used by nonclinicians. The DIS assesses both current and past symptoms and is available in a computerized version. It has been translated into a number of languages, including Spanish and Chinese.

Role of the Social Network

As with screening, it often helps to interview members of the person’s social network to confirm information and to get additional information. This may include caregivers, family members, friends, and neighbors.

Interviewing family members may be a problem in some cases. Early-onset alcohol abusers may have alienated family members. A common law or other partner may be the most knowledgeable informant. In addition, in a retirement or residential care facility, staff or other residents may have observed more problems with alcohol than family members.

Another problem is that other family members may have problems with drugs or alcohol and may have enabled the older person’s drinking. They may feel threatened by an interview or minimize or evade the issue of substance abuse.

It may be preferable to conduct home visits. One can observe the client’s behavior in familiar surroundings, his or her ability to keep up a personal residence, demonstration of IADLs, the safety of the house and neighborhood, and proximity to transportation and shopping, including liquor stores.

Available Instruments

Case Study

Check your knowledge about assessment issues with this case study.

<< Previous Page     Next Page >>