SCREENING FOR ALCOHOL-USE DISORDERS IN THE NURSING-HOME

OBJECTIVES: To determine the prevalence of Alcohol Use Disorders (AUDs ) among residents of a Veterans Affairs (VA) nursing home (NH) using D SM-III-R criteria for alcohol abuse and dependence,and to examine the demographic variables associated with AUDs among NH residents. A third objective was to assess the sensitivity, compared with DSM-III-R crit eria, of three screening tests for AUDs in the NH: the CAGE, the MAST- G, and the two-question instrument developed by Cyr and Wartman. DESIG N: A cross-sectional design, with DSIM-III-R criteria determined by th e alcohol module of the Diagnostic Interview Schedule (DIS) as the cri terion standard. PATIENTS: Patients older than age 50 admitted consecu tively to a VA NH, n = 117. MAIN OUTCOME MEASURES: Sensitivities, spec ificities, positive predictive values for the CAGE, MAST-G, and Cyr an d Wartman Screening questionnaires; receiver operating characteristic (ROC) curves for the CAGE and MAST-G. MAIN RESULTS: Forty-nine percent of study participants met DSM-III-R criteria for lifetime alcohol abu se or dependence (18% active, 31% inactive). The sensitivities and spe cificities of the three screening questionnaires were as follows: CAGE -82% and 90%; MAST-G-93% and 65%; Cyr and Wartman-70% and 92%, respect ively. The area under the ROC curve was 0.94 for the CAGE and 0.90 for the MAST-G. CONCLUSIONS: The prevalence of lifetime alcohol abuse and dependence was high in this VA NH population. Both the CAGE and MAST- G are sensitive to AUDs in this setting. The areas under the ROC curve s were not significantly different and indicate both tests discriminat ed well between NH residents with and without AUDs.