Identification and characterization of older emergency department patients with high-risk alcohol use

Background: High-risk alcohol use in the elderly is a common but underrecognized problem. We tested a brief screening instrument to identify high-risk individuals.

Methods: This was a prospective, cross-sectional study conducted at a single emergency department. High-risk alcohol use was defined by National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines as >7 drinks/week or >3 drinks/occasion. We assessed alcohol use in patients aged ≥ 65 years using the timeline follow back (TLFB) method as a reference standard and a new, 2-question screener based on NIAAA guidelines. The Alcohol Use Disorders Identification Test (AUDIT) and Cut down, Annoyed, Guilty, Eye-opener (CAGE) screens were used for comparison. We collected demographic information from a convenience sample of high- and low-risk drinkers.

Results: We screened 2250 older adults and 180 (8%) met criteria for high-risk use. Ninety-eight high-risk and 124 low-risk individuals were enrolled. The 2-question screener had sensitivity of 98% (95% CI, 93%-100%) and specificity of 87% (95% CI, 80%-92%) using TLFB as the reference. It had higher sensitivity than the AUDIT or CAGE tools. The high-risk group was predominantly male (65% vs 35%, P < 0.001). They drank a median of 14 drinks per week across all ages from 65 to 92. They had higher rates of prior substance use treatment (17% vs 2%, P < 0.001) and current tobacco use (24% vs 9%, P = 0.004).

Conclusion: A rapid, 2-question screener can identify high-risk drinkers with higher sensitivity than AUDIT or CAGE screening. It could be used in concert with more specific questionnaires to guide treatment.