Screening for problem drinking in older people referred to a mental health service: A comparison of CAGE and AUDIT

Abstract

The aim of the study was to evaluate the validity of the Alcohol Use Disorders Identification Test (AUDIT), the five-item version (AUDIT-5) and the CAGE as screening tests for problem drinking in mentally ill older people. The study was of prospective cross-sectional design with questionnaire survey and interview and included all consecutive referrals to an old age psychiatry service fulfilling inclusion criteria. Sensitivity, specificity and positive predictive values and areas under the receiver operating characteristic curves (AUROC) for the AUDIT, AUDIT-5, and CAGE were the primary outcome measures. Using clinical criteria as the gold standard, the AUDIT, AUDIT-5 and CAGE had AUROCs of 0.961, 0.964, and 0.780 respectively. The AUDIT-5 performed best of the three scales with a sensitivity of 75.0%, specificity of 97.2% and positive predictive value of 83.3% when using a 4/5 cut-point. The AUDIT-5 performed as well as the AUDIT and better than the CAGE in identifying problem drinking in this sample. The AUDIT-5 may be a useful addition to the specialist mental health assessment of older people.

Alcohol Use Disorders Identification Test (AUDIT): An updated systematic review of psychometric properties.

“…Several studies prove the significant increase in alcohol-related problems among the elderly, which are frequently neglected in health care units (Philpot et al, 2003). Thus, the need for new AUDIT evaluation research in this group is highlighted, due to the low sensitivity values obtained and the need to verify a more suitable cut-off point, since alcohol tolerance tends to be reduced in older individuals (Reinert & Allen, 2007).…”

“…The study was conducted with a sample of psychiatric patients, and aimed to evaluate and compare the performances of the AUDIT, AUDIT-5, and CAGE. The patients' clinical data were used as diagnostic criteria to evaluate alcohol consumption (Philpot et al, 2003). The area under the curve was .96 for the AUDIT; 0.96 for the AUDIT-5; and .78 for the CAGE.…”

Evaluation of health parameters, use of drugs, and alcohol intake among an elderly population in São José dos Campos, SP, Brazil

“…It can be argued that specific tests such as AUDIT have a better performance in the elderly compared to young people 21 , and AUDIT seems to be a reliable method to identify alcohol-related problems and assist in planning appropriate services for the treatment and prevention of alcoholism 4 . To calculate the frequency of alcohol intake, scores were assigned to each question, and after that the final score was obtained.…”

“…This test was designed by the World Health Organization to identify disorders caused by alcohol abuse in facilities for primary health care 4 , and it has been shown to be valid in the detection of dangerous alcohol use in large-scale studies with active adults and elderly patients [12][13] . A BrazilianPortuguese version of the test had been previously validated 10,14 and was used in this study.…”

“…Alcohol addiction prevalence is currently lower in people over 65 years compared to other age groups, but there is some evidence of a growing proportion of elderly people who use alcohol at inappropriate levels. Because older people are more vulnerable to alcohol's effects, the current definitions of abuse and alcohol dependence may also be more stringent for this population 4 . Although alcohol-related problems are common among the elderly, physicians almost never recognize them early because of the difficulty in making early diagnoses, since the problems related to alcohol are not usually addressed in elderly patients 5 , especially in women 6 .…”