Characteristics of Emergency Department Visits Among Midlife and Older Adults Screening Positive for Alcohol Misuse

Alcohol misuse among midlife and older adults is increasing, and age-related physiological vulnerability heightens the risk for adverse outcomes. Emergency departments (EDs) are key health system touchpoints for identifying alcohol misuse, yet the delivery of evidence-based interventions following screening in this population remains poorly described.

We conducted a retrospective cohort study of ED encounters from January 1, 2019-December 31, 2023, across 11 hospital-based EDs in a large integrated health system. We included patients aged ≥ 55 years old who screened positive for alcohol misuse using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C; ≥ 4 for men, ≥ 3 for women). Primary outcomes were delivery of evidence-based interventions, including brief intervention and referral to treatment and provision of medication for alcohol use disorder (MAUD). Secondary measures included demographics, co-occurring substance use, clinical presentation, and health care utilization. Age-adjusted logistic regression evaluated associations between AUDIT-C score and outcomes.

Of 698,308 ED encounters among adults aged ≥ 55 years old, 39,912 (5.7%) screened positive for alcohol misuse. Men accounted for 58% of encounters, with gender differences narrowing with age. Co-use of substances was common: 21% reported illicit drug use, 27% cannabis use, and 23% tobacco use, with higher prevalence in younger age groups. Recent opioid and benzodiazepine prescriptions were documented in 12% and 6% of encounters, respectively. Brief intervention and referral to treatment occurred in 30% of encounters overall and in 46% among those with severe misuse. Despite guideline support for pharmacotherapy, MAUD was prescribed in only 3% of encounters.

Among midlife and older ED patients who screen positive for alcohol misuse, delivery of evidence-based interventions, particularly pharmacotherapy, is uncommon despite substantial healthcare utilization and co-occurring risk factors. These findings highlight a gap between identification and treatment and underscore the ED's potential role in initiating evidence-based interventions for alcohol misuse.