Screening for Alcohol Use Disorders

The CAGE and the Alcohol Use Disorders Identification Test (AUDIT), are the most frequently used tools for screening alcohol dependence and hazardous use in the general population, and are validated for older populations as well. Lowering the cut off points for AUDIT to =5; and for AUDIT-C (Alcohol Use Disorders Identification Test- Consumption) to =4 has been recommended in order to improve their sensitivity in older people. 

Regardless of the health care setting, a screening for harmful alcohol use should be undertaken for all new patients over 50 years old and reviewed at regular intervals, that is, at least once a year with a view to document for use and misuse.  

For older adults who present with unexplained physical and psychological symptomatology and inconsistencies or contradictions in the presentation, as well as the major life events, should prompt re-screening for, or assessment of alcohol and other substance use. 

People who are older and drink that are taking other medications, in particular those taking multiple medications or psychoactive medications (e.g. sedatives, anti-depressants), should have medications reviewed by their medical practitioner to assess for any drug interactions. 

Due to alcohol’s impact on overall well-being, a comprehensive assessment should include physical, mental and cognitive capacity, nutrition, chronic pain, social conditions, overall general functioning, and a review of medications. 

The severity and management of concomitant physical and mental conditions should be reviewed several weeks to months after cessation of drinking and completion of withdrawal. Abstinence can be associated with marked improvements in other conditions (such as hypertension, cognitive function, mental state). Alternatively, alcohol use may have been masking underlying illness.