Advertisement

Screening Older Adults for Alcohol Use

Published:September 22, 2022DOI:https://doi.org/10.1016/j.nurpra.2022.08.015

      Highlights

      • Rates of alcohol use among older adults are increasing.
      • Older adults are less likely to be screened than younger people.
      • Research and guidance on best practices for screening are limited.
      • Traditional tools may not accurately assess older people.
      • Alcohol screening should be performed regardless of the method.

      Abstract

      The number of older adults engaging in unhealthy alcohol use is on the rise, and this trend is expected to continue as the population ages. However, the likelihood a provider will ask an older adult about their alcohol use decreases with age. Geriatric screening tools take into account the particular features of alcohol use in older adults, but minimal research and guidance are available regarding the best method for screening. Lack of knowledge and time are significant obstacles to adequate assessment. Simply asking about alcohol consumption may be the best approach to evaluate the drinking habits of older patients.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal for Nurse Practitioners
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Grant B.F.
        • Chou S.P.
        • Saha T.D.
        • et al.
        Prevalence of 12-month alcohol use, high-risk drinking, and DSM-IV alcohol use disorder in the United States, 2001-2002 to 2012-2013: results from the National Epidemiologic Survey on Alcohol and Related Conditions.
        JAMA Psychiatry. 2017; 74: 911-923https://doi.org/10.1001/jamapsychiatry.2017.2161
        • Han B.H.
        • Moore A.A.
        • Sherman S.
        • Keyes K.M.
        • Palamar J.J.
        Demographic trends of binge alcohol use and alcohol use disorders among older adults in the United States, 2005-2014.
        Drug Alcohol Depend. 2017; 170: 198-207https://doi.org/10.1016/j.drugalcdep.2016.11.003
        • Joshi P.
        • Duong K.T.
        • Trevisan L.A.
        • Wilkins K.M.
        Evaluation and management of alcohol use disorder among older adults.
        Curr Geriatr Rep. 2021; 10: 82-90https://doi.org/10.1007/s13670-021-00359-5
        • McKnight-Eily L.R.
        • Okoro C.A.
        • Turay K.
        • Acero C.
        • Hungerford D.
        Screening for alcohol use and brief counseling of adults - 13 states and the District of Columbia, 2017.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 265-270https://doi.org/10.15585/mmwr.mm6910a3
        • Sahker E.
        • Arndt S.
        Alcohol use screening and intervention by American primary care providers.
        Int J Drug Policy. 2017; 41: 29-33https://doi.org/10.1016/j.drugpo.2016.11.013
        • Fernandez A.
        • Kullgren J.
        • Malani P.
        • Singer D.
        • Kirch M.
        • Solway E.
        University of Michigan National Poll on Healthy Aging: alcohol use among older adults.
        (Published June 9, 2021)
        • Han B.H.
        • Moore A.A.
        • Ferris R.
        • Palamar J.J.
        Binge drinking among older adults in the United States, 2015 to 2017.
        J Am Geriatr Soc. 2019; 67: 2139-2144https://doi.org/10.1111/jgs.16071
        • Bankole A.
        Impact of coronavirus disease 2019 on geriatric psychiatry.
        Psychiatr Clin North Am. 2022; 45: 147-159https://doi.org/10.1016/j.psc.2021.11.010
        • Eastman M.R.
        • Finlay J.M.
        • Kobayashi L.C.
        Alcohol use and mental health among older American adults during the early months of the COVID-19 pandemic.
        Int J Environ Res Public Health. 2021; 18: 4222https://doi.org/10.3390/ijerph18084222
        • Capasso A.
        • Jones A.M.
        • Ali S.H.
        • Foreman J.
        • Tozan Y.
        • DiClemente R.J.
        Increased alcohol use during the COVID-19 pandemic: the effect of mental health and age in a cross-sectional sample of social media users in the U.S.
        Prev Med. 2021; 145: 106422https://doi.org/10.1016/j.ypmed.2021.106422
        • Nordeck C.D.
        • Riehm K.E.
        • Smail E.J.
        • et al.
        Changes in drinking days among United States adults during the COVID-19 pandemic.
        Addiction. 2022; 117: 331-340https://doi.org/10.1111/add.15622
        • DiBartolo M.C.
        • Jarosinski J.M.
        Alcohol use disorder in older adults: challenges in assessment and treatment.
        Issues Ment Health Nurs. 2017; 38: 25-32https://doi.org/10.1080/01612840.2016.1257076
        • Roth J.A.
        • Bradley K.
        • Thummel K.E.
        • Veenstra D.L.
        • Boudreau D.
        Alcohol misuse, genetics, and major bleeding among warfarin therapy patients in a community setting.
        Pharmacoepidemiol Drug Saf. 2015; 24: 619-627https://doi.org/10.1002/pds.3769
        • Gorsen S.L.
        • Mehuys E.
        • De Bolle L.
        • Boussery K.
        • Tommelein E.
        Prevalence of alcohol-drug interactions in community-dwelling older patients with polypharmacy.
        Drug Metab Pers Ther. 2021; 36: 281-288
        • United States Preventive Services Task Force
        Final Recommendation Statement: Unhealthy Alcohol Use in Adolescents and Adults: Screening and Behavioral Counseling Recommendations. uspreventiveservicestaskforce.org.
        (Published November 13, 2018)
        • Substance Abuse and Mental Health Services Administration
        Treating substance use disorder in older adults (Treatment Improvement Protocol 26).
        (Updated, 2020)
        • Colburn J.L.
        • Nothelle S.
        The Medicare Annual Wellness Visit.
        Clin Geriatr Med. 2018; 34: 1-10https://doi.org/10.1016/j.cger.2017.09.001
        • U.S. Department of Agriculture and U.S
        Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025.
        (9th ed. December 2020)
        • Blow F.C.
        • Brower K.J.
        • Schulenberg J.E.
        • Demo-Dananberg L.M.
        • Young J.P.
        • Beresford T.P.
        The Michigan Alcoholism Screening Test- Geriatric version (MAST-G): a new elderly specific screening instrument.
        Alcohol Clin Exp Res. 1992; 16: 372https://doi.org/10.1111/j.1530-0277.1992.tb01393.x
        • Blow F.C.
        • Gillespie B.W.
        • Barry K.L.
        • Mudd S.A.
        • Hill E.M.
        Brief screening of alcohol problems in elderly populations using the Short Michigan Alcoholism Screening Test- Geriatric version (SMAST-G).
        Alcohol Clin Exp Res. 1992; 22: 31Ahttps://doi.org/10.1111/j.1530-0277.1998.tb04347.x
        • Moore A.A.
        • Seeman T.
        • Morgenstern H.
        • Beck J.C.
        • Reuben D.B.
        Are there differences between older persons who screen positive on the CAGE questionnaire and the Short Michigan Alcoholism Screening Test-Geriatric Version?.
        J Am Geriatr Soc. 2002; 50: 858-862https://doi.org/10.1046/j.1532-5415.2002.50211.x
        • Knightly R.
        • Tadros G.
        • Sharma J.
        • et al.
        Alcohol screening for older adults in an acute general hospital: FAST v. MAST-G assessments.
        BJPsych Bull. 2016; 40: 72-76https://doi.org/10.1192/pb.bp.114.049734
        • Fink A.
        • Tsai M.C.
        • Hays R.D.
        • et al.
        Comparing the alcohol-related problems survey (ARPS) to traditional alcohol screening measures in elderly outpatients.
        Arch Gerontol Geriatr. 2002; 34: 55-78https://doi.org/10.1016/s0167-4943(01)00198-4
        • Moore A.A.
        • Beck J.C.
        • Babor T.F.
        • Hays R.D.
        • Reuben D.B.
        Beyond alcoholism: identifying older, at-risk drinkers in primary care.
        J Stud Alcohol. 2002; 63: 316-324https://doi.org/10.15288/jsa.2002.63.316
        • Fink A.
        • Morton S.C.
        • Beck J.C.
        • et al.
        The alcohol-related problems survey: identifying hazardous and harmful drinking in older primary care patients.
        J Am Geriatr Soc. 2002; 50: 1717-1722https://doi.org/10.1046/j.1532-5415.2002.50467.x
        • Ewing J.A.
        Detecting alcoholism. The CAGE questionnaire.
        JAMA. 1984; 252: 1905-1907https://doi.org/10.1001/jama.252.14.1905
        • Morton J.L.
        • Jones T.V.
        • Manganaro M.A.
        Performance of alcoholism screening questionnaires in elderly veterans.
        Am J Med. 1996; 101: 153-159https://doi.org/10.1016/s0002-9343(96)80069-6
        • Adams W.L.
        • Barry K.L.
        • Fleming M.F.
        Screening for problem drinking in older primary care patients.
        JAMA. 1996; 276: 1964-1967
        • Hinkin C.H.
        • Castellon S.A.
        • Dickson-Fuhrman E.
        • Daum G.
        • Jaffe J.
        • Jarvik L.
        Screening for drug and alcohol abuse among older adults using a modified version of the CAGE.
        Am J Addict. 2001; 10: 319-326
        • Shenvi C.L.
        • Weaver M.A.
        • Biese K.J.
        • et al.
        Identification and characterization of older emergency department patients with high-risk alcohol use.
        J Am Coll Emerg Physicians Open. 2020; 1: 804-811https://doi.org/10.1002/emp2.12196
        • Babor T.F.
        • Higgins-Biddle J.C.
        • Saunders J.B.
        • Monteiro M.G.
        AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care.
        (2nd ed. Published, 2001)
        who.int/publications/i/item/WHO-MSD-MSB-01.6a
        Date accessed: January 20, 2022
        • Aalto M.
        • Alho H.
        • Halme J.T.
        • Seppä K.
        The Alcohol Use Disorders Identification Test (AUDIT) and its derivatives in screening for heavy drinking among the elderly.
        Int J Geriatr Psychiatry. 2011; 26: 881-885https://doi.org/10.1002/gps.2498
        • Cusack L.
        • Kelly J.
        • Groenkjaer M.
        • Wilkinson C.
        • Harland J.
        Acceptability and suitability of alcohol, smoking and substance involvement screening test for older people in the community.
        Contemp Nurse. 2019; 55: 486-494https://doi.org/10.1080/10376178.2019.1661785
        • Bareham B.K.
        • Stewart J.
        • Kaner E.
        • Hanratty B.
        Factors affecting primary care practitioners' alcohol-related discussions with older adults: a qualitative study.
        Br J Gen Pract. 2021; 71: e762-e771https://doi.org/10.3399/BJGP.2020.1118
        • Kelly S.
        • Olanrewaju O.
        • Cowan A.
        • Brayne C.
        • Lafortune L.
        Alcohol and older people: a systematic review of barriers, facilitators and context of drinking in older people and implications for intervention design.
        PLoS One. 2018; 13: e0191189https://doi.org/10.1371/journal.pone.0191189
        • Bareham B.K.
        • Kaner E.
        • Spencer L.
        • Hanratty B.
        Health and social care providers' perspectives of older people's drinking: a systematic review and thematic synthesis of qualitative studies.
        Age Ageing. 2020; 49: 453-467https://doi.org/10.1093/aging/afaa005
        • Lehmann S.W.
        • Fingerhood M.
        Substance-use disorders in later life.
        N Engl J Med. 2018; 379: 2351-2360https://doi.org/10.1056/NEJMra1805981

      Biography

      Marie Briggs, MSN, RN, CHPN, is a nurse at Promedica Hospice in Buffalo Grove, IL, and can be contacted at [email protected] .

      Biography

      Amanda Peacock, DNP, APRN, AGNP-C is a Clinical Assistant Professor and Director of Adult Primary Care Nurse Practitioner Program at Niehoff School of Nursing, Loyola University.