Screening for alcohol misuse in older people

Area of Science:

• Geriatric Medicine
• Addiction Psychiatry
• Public Health Screening

Background:

• Alcohol misuse is a significant health concern in older adults.
• Effective screening tools are crucial for early identification and intervention.
• Current instruments like CAGE, MAST-G, and mean corpuscular volume (MCV) have shown variable efficacy in this demographic.

Purpose of the Study:

• To assess the effectiveness of CAGE, MAST-G, and high MCV as screening instruments for alcohol misuse in patients aged 65 and over.
• To develop a novel screening instrument if existing methods prove inadequate.

Main Methods:

• A questionnaire survey was conducted on randomly selected patients aged 65 and over admitted to acute admission wards in two district general hospitals over a 9-month period.
• The study evaluated the sensitivity of CAGE, MAST-G, and high MCV in identifying excessive alcohol intake and alcohol dependence.

Main Results:

• The sensitivities of the CAGE questionnaire, the Michigan Alcohol Screening Test-Geriatric version (MAST-G), and an abnormally high mean corpuscular volume (MCV) for detecting excess alcohol intake and alcohol abuse were found to be low, ranging from 0.13 to 0.54.
• These findings indicate poor performance of the evaluated instruments in this specific patient population.

Conclusions:

• The study confirms that CAGE and high MCV are poor screening instruments for alcohol misuse in older patients, consistent with previous UK research.
• The MAST-G also demonstrated low sensitivity, suggesting it is an insensitive screening tool for this age group.
• A new, five-question, two-step screening instrument was developed and requires further validation to assess its efficacy.