Identification and characterization of older emergency department patients with high‐risk alcohol use
Background High‐risk alcohol use in the elderly is a common but underrecognized problem. We tested a brief screening instrument to identify high‐risk individuals. Methods This was a prospective, cross‐sectional study conducted at a single emergency department. High‐risk alcohol use was defined by Na...
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| Published in | Journal of the American College of Emergency Physicians Open Vol. 1; no. 5; pp. 804 - 811 |
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| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
John Wiley and Sons Inc
01.10.2020
Wiley |
| Subjects | |
| Online Access | Get full text |
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| Summary: | Background
High‐risk alcohol use in the elderly is a common but underrecognized problem. We tested a brief screening instrument to identify high‐risk individuals.
Methods
This was a prospective, cross‐sectional study conducted at a single emergency department. High‐risk alcohol use was defined by National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines as >7 drinks/week or >3 drinks/occasion. We assessed alcohol use in patients aged ≥ 65 years using the timeline follow back (TLFB) method as a reference standard and a new, 2‐question screener based on NIAAA guidelines. The Alcohol Use Disorders Identification Test (AUDIT) and Cut down, Annoyed, Guilty, Eye‐opener (CAGE) screens were used for comparison. We collected demographic information from a convenience sample of high‐ and low‐risk drinkers.
Results
We screened 2250 older adults and 180 (8%) met criteria for high‐risk use. Ninety‐eight high‐risk and 124 low‐risk individuals were enrolled. The 2‐question screener had sensitivity of 98% (95% CI, 93%–100%) and specificity of 87% (95% CI, 80%–92%) using TLFB as the reference. It had higher sensitivity than the AUDIT or CAGE tools. The high‐risk group was predominantly male (65% vs 35%, P < 0.001). They drank a median of 14 drinks per week across all ages from 65 to 92. They had higher rates of prior substance use treatment (17% vs 2%, P < 0.001) and current tobacco use (24% vs 9%, P = 0.004).
Conclusion
A rapid, 2‐question screener can identify high‐risk drinkers with higher sensitivity than AUDIT or CAGE screening. It could be used in concert with more specific questionnaires to guide treatment. |
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| Bibliography: | 3. CL Shenvi, T Platts‐Mills, Y Fatade, M Weaver, K Biese, J Busby‐Whitehead, G D'Onofrio, "A Comparison of Older Adults with Low‐Risk and High‐Risk Alcohol Use in the Emergency Department," Society for Academic Emergency Medicine Annual Meeting, May 2016, New Orleans, LA Supervising Editor: Alexander S. Lo, MD, PhD. 2. CL Shenvi, T Platts‐Mills, Y Fatade, M Weaver, K Biese, J Busby‐Whitehead, G D'Onofrio, "A Comparison of Older Adults with Low‐Risk and High‐Risk Alcohol Use in the Emergency Department," GEMSSTAR U13 Conference, September 2016, Washington, DC Meeting Presentations Parts of this work were presented at the following conferences, but with incomplete data, as data collection was ongoing 1. J. Griffeth, Y. Fatade, T. Platts‐Mills, M. Weaver, K. Biese, G. D'Onofrio, J. Busby‐Whitehead, C. Shenvi, “Comparing High‐Risk and Low‐Risk Drinking in Older Adults,” presented by J. Griffeth at the American Geriatrics Society Annual Meeting, May 2017, San Antonio, TX 4. Y Fatade, T Platts‐Mills, M Weaver, K Biese, J Busby‐Whitehead, G D'Onofrio, CL Shenvi, "A Comparison of Older Adults with Low‐Risk and High‐Risk Alcohol Use in the Emergency Department," presented by Y Fatade at the American Geriatrics Society Annual Meeting, May 2016, Long Beach, CA Funding and support Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Number R03AG048090, by a Dennis W. Jahnigen Career Development Award, a grant from the American Geriatrics Society and funded by The John A. Hartford Foundation and the Society for Academic Emergency Medicine, by the T35 AG038047 ‐ UNC‐CH Summer Research Training in Aging for Medical Students, and by the Clinical and Translational Science Award program of the Division of Research Resources, National Institute of Health, ULTR001111. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or other funding entity. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Meeting Presentations: Parts of this work were presented at the following conferences, but with incomplete data, as data collection was ongoing Funding and support: Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Number R03AG048090, by a Dennis W. Jahnigen Career Development Award, a grant from the American Geriatrics Society and funded by The John A. Hartford Foundation and the Society for Academic Emergency Medicine, by the T35 AG038047 ‐ UNC‐CH Summer Research Training in Aging for Medical Students, and by the Clinical and Translational Science Award program of the Division of Research Resources, National Institute of Health, ULTR001111. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or other funding entity. |
| ISSN: | 2688-1152 2688-1152 |
| DOI: | 10.1002/emp2.12196 |