Screening for alcohol use disorders in the nursing home

Area of Science:

• Geriatric Medicine
• Addiction Psychiatry
• Public Health

Background:

• Alcohol Use Disorders (AUDs) are prevalent in older adults.
• Veterans Affairs (VA) nursing homes (NHs) care for a significant population of older veterans.
• Screening for AUDs in NH settings is crucial for appropriate management.

Purpose of the Study:

• Determine the prevalence of AUDs in VA NH residents using DSM-III-R criteria.
• Identify demographic factors associated with AUDs in this population.
• Evaluate the sensitivity and specificity of three AUD screening tests: CAGE, MAST-G, and Cyr and Wartman.

Main Methods:

• Cross-sectional study design.
• Diagnostic Interview Schedule (DIS) alcohol module used as the criterion standard for DSM-III-R AUD diagnosis.
• 117 consecutive residents over age 50 admitted to a VA NH were assessed.

Main Results:

• 49% of participants met DSM-III-R criteria for lifetime AUD (18% active, 31% inactive).
• Screening test performance: CAGE (82% sensitivity, 90% specificity), MAST-G (93% sensitivity, 65% specificity), Cyr and Wartman (70% sensitivity, 92% specificity).
• Receiver operating characteristic (ROC) curve analysis showed strong discrimination for CAGE (0.94 area) and MAST-G (0.90 area).

Conclusions:

• Lifetime AUD prevalence is high among VA NH residents.
• Both CAGE and MAST-G demonstrate good sensitivity for detecting AUDs in this geriatric population.
• Both CAGE and MAST-G effectively discriminate between NH residents with and without AUDs.