PERFORMANCE OF ALCOHOLISM SCREENING QUESTIONNAIRES IN ELDERLY VETERANS

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.