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

Abstract

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.

Recurrent risk of hospitalization among older people with problematic alcohol use: a multiple failure‐time analysis with a discontinuous risk model

“…More than 10% (n = 183) were hospitalized at least once with dual alcohol use and psychiatric disorders. Previous cross-sectional analysis of older samples from emergency departments, medical and psychiatric inpatient stays reported a high prevalence of alcohol use disorder [15,[42][43][44][45]. Our study found an increased risk of hospitalization and mortality among older addiction service users in a F I G U R E Analysis cohort 14-year study period.…”

Use of a Brief Negotiation Interview in the emergency department to reduce high‐risk alcohol use among older adults: A randomized trial

“…Additional low-risk drinkers were enrolled, as reported on the registration, in a parallel study to compare the characteristics of high-risk and low-risk drinkers. 16 The study was conducted at a single, academic, level 1 trauma center in the southeast United States that serves a socioeconomically diverse population with 70,000 visits annually, of which 16% are patients aged >64 years. ing is defined as ≥1 binge-drinking episodes in the past 3 months or an average of ≥8 drinks per week.…”

“…These 2 screening questions can rapidly and accurately identify high-risk alcohol use in the ED. 16 Patients were randomized in a 1:1 allocation using randomly permuted blocks with randomly selected block sizes of 8 or 12. Sequential group assignment papers were placed in sealed, numbered envelopes.…”

“…During the enrollment period, 2250 ED patients aged ≥65 years were screened for high-risk alcohol use based on NIAAA guidelines. 16 A total of 183 (8%) met the criteria for high-risk alcohol use. All highrisk patients were screened using the further eligibility criteria, and 98 (53%) were enrolled.…”

Gender-specific characteristics of alcohol use in community-dwelling older adults in Belgium

“…Alcohol use (AU) among older adults has typically been seen as a male activity. Most studies reported higher prevalence of AU among older men in comparison to older women (Carvalho et al, 2018;Li et al, 2019;Rossow & Traeen, 2020;Shenvi et al, 2020). Recently a noticeable increase in AU among older adults has been observed, especially in older women (Bye & Moan, 2020;Grant et al, 2017).…”