PURPOSE: TO validate three alcoholism screening questionnaires in elde
rly male veterans. PATIENTS: Participants were 120 male veterans aged
65 years or older. METHODS: In this cross-sectional study, consecutive
patients in the outpatient general medical practice at the Omaha VA M
edical Center were interviewed with the alcohol module of the Revised
Diagnostic Interview Schedule (DIS-III-R) and three alcoholism screeni
ng questionnaires, the Michigan Alcoholism Screening Test-Geriatric Ve
rsion (MAST-G), the CAGE, and the Alcohol Use Disorders Identification
Test (AUDIT). Performance characteristics (sensitivity, specificity,
predictive values, likelihood ratios, and areas under the receiver ope
rating curve [ROC]) of the screening questionnaires were determined in
comparison with the DIS-III-R. RESULTS: Forty-three participants (36%
) met DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders
) criteria for alcohol abuse or dependence; 23% were active drinkers a
nd 13% were inactive. Fifty of the 120 (42%) reported abstinence from
drinking during the preceding year. A MAST-G score greater than or equ
al to 5 had a sensitivity and specificity of 70% and 81%, respectively
. A CAGE score greater than or equal to 2 had a sensitivity and specif
icity of 63% and 82%. Using active drinkers only, an AUDIT score of gr
eater than or equal to 8 had a sensitivity and specificity of 33% and
91%. The positive predictive values (PPV) for the MAST-G, CAGE, and AU
DIT were 67%, 66%, and 69%, respectively; the negative predictive valu
es were 83%, 80%, and 68%, respectively. Areas under the receiver oper
ating curves for the MAST-G, CAGE, and AUDIT were 0.84 +/- 0.04, 0.77
+/- 0.05, and 0.56 +/- 0.08, respectively. CONCLUSION: The MAST-G and
the CAGE outperformed the AUDIT for detecting alcohol abuse and depend
ence in an elderly male veteran population. The CAGE, requiring only f
our easily memorized questions to achieve similar accuracy, appears to
offer an advantage over the 24-item MAST-G.