SCREENING FOR PROBLEM DRINKING IN OLDER PRIMARY-CARE PATIENTS

Objectives.-To describe potentially hazardous alcohol use among elderl y patients in the primary care setting and to assess the widely used C AGE questionnaire (cut down, annoyed by criticism, guilty about drinki ng, eye-opener drinks) as a tool for detecting self-reported heavy and binge drinking among these patients. Design.-Cross-sectional study. S etting.-The offices of 88 primary care physicians at 21 sites in south eastern Wisconsin. Patients.-A total of 5065 consecutive consenting pa tients older than 60 years.Measures.-A previously validated self-admin istered questionnaire that included beverage-specific questions about the quantity and frequency of regular drinking in the last 3 months, t he number of episodes of binge drinking (6 drinks per occasion), and t he CAGE questionnaire. Results.-Fifteen percent of men and 12% of wome n regularly drank in excess of limits recommended by the National Inst itute of Alcohol Abuse and Alcoholism (>7 drinks per week for women an d >14 drinks per week for men). Nine percent of men and 2% of women re ported regularly consuming more than 21 drinks per week. When we admin istered the CAGE questionnaire, 9% of men and 3% of women screened pos itive for alcohol abuse within 3 months. The CAGE performed poorly in detecting heavy or binge drinkers; fewer than half were CAGE positive when the standard cutoff of 2 positive answers was used. Conclusions.- Alcohol consumption in excess of recommended limits is common among el derly outpatients. The CAGE questionnaire alone is insufficient to det ect such drinking. Asking questions on the quantity and frequency of d rinking in addition to administering the CAGE increases the number of problem drinkers detected.