Screening and identification of older adults with alcohol problems in primary care

Primary care physicians can anticipate encountering more elderly patients w ith alcohol problems since this population is increasing and the prevalence of alcohol problems has been stable. Brief screening tools, originally dev eloped and validated among younger adults, may not be appropriate in the el derly. Therefore, specific validation studies and the development of elderl y specific instruments have been reported. The specific goals of this repor t are to (1) review available screening tools for alcohol problems, (2) sum marize elderly focused studies, and (3) provide recommendations for use in primary care. Using a variety of standards, the CAGE (Cut down, Annoyed, Gu ilty, and Eye opener) is the most consistent brief screen, but its threshol d may need to be adjusted in the elderly. The Michigan Alcoholism Screening Test-Geriatric Version includes elderly-specific consequences, but its len gth may hinder routine use even in shortened form. Finally, the Alcohol Use Disorders Identification Test, although less sensitive than the CAGE, can also capture problem drinkers. Efforts are needed to include elderly-specif ic consequences and meaningful consumption thresholds in a brief, easily ap plied screen.