title: Screening for alcohol and substance use for older people in geriatric hospital and community health settings.
abstract: BACKGROUND
  We aimed to determine the rates of alcohol and substance use in geriatric hospital and community health settings, and to evaluate the performance of screening instruments.
  
  
  METHODS
  A two-phase cross-sectional study was undertaken in geriatric and aged care psychiatry wards and associated community services of a teaching hospital. Participants were screened with the Brief Alcohol Use Disorders Identification Test (AUDIT-C) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for other substances; Geriatric Depression Scale-15 for mood; the Connor-Davidson Resilience Scale; and the Subjective Quality of Life scale. Medical conditions were established. Screen positives for risky substance use continued with the full AUDIT, full ASSIST, CAGE, Addenbrooke's Cognitive Examination-Revised, and the Functional Activities Questionnaire. Medical records were reviewed after three months to ascertain recognition and management of substance use.
  
  
  RESULTS
  Of 210 participants aged 60+ (mean age 81.9, 63.3% female) without dementia or delirium and Mini Mental State Examination score ≥24, 41 (19.5%) were screen positive - 36 (17.1%) for alcohol, seven for non-medical benzodiazepine use (3.3%) (four alcohol and benzodiazepine) and two for non-medical opioid use (0.95%). Screen positives differed from screen negatives on few demographic or health measures. On the ASSIST, 26 (12.4%) were rated as medium/high risk. The AUDIT-C with cut-point of ≥5 was the optimal measure for detecting risky alcohol use.
  
  
  CONCLUSIONS
  Many patients in geriatric health services have risky alcohol or substance use, but few clinical features distinguish them from other patients. Routine screening of alcohol and substance use is recommended.
authors.affiliation: School of Psychiatry,University of NSW,Sydney,Australia.
authors.forename: Brian
authors.initials: B
authors.lastname: Draper
authors.affiliation: Dementia Collaborative Research Centre,University of New South Wales,Sydney,Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Ridley
authors.affiliation: Centre for Emotional Health,Department of Psychology,Macquarie University,Sydney,Australia & Dementia Collaborative Research Centre,University of New South Wales,Sydney,Australia.
authors.forename: Carly
authors.initials: C
authors.lastname: Johnco
authors.affiliation: School of Public Health & Community Medicine,University of NSW,SydneyAustralia.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Withall
authors.affiliation: Department of Geriatric Medicine,Prince of Wales Hospital,Randwick,NSW,Australia.
authors.forename: Welkee
authors.initials: W
authors.lastname: Sim
authors.affiliation: Community Health Assessment and Therapy Team,Prince of Wales Hospital,Randwick,NSW,Australia.
authors.forename: Matilda
authors.initials: M
authors.lastname: Freeman
authors.affiliation: ARC Centre of Excellence in Cognition and its Disorders,Department of Cognitive Science,Macquarie University,Sydney,Australia & Dementia Collaborative Research Centre,University of New South Wales,Sydney,Australia.
authors.forename: Erika
authors.initials: E
authors.lastname: Contini
authors.affiliation: South East Sydney Local Health District D&A Services,The Langton Centre,591 Sth Dowling St,Surry Hills,Sydney & Division of Addiction Medicine,Faculty of Medicine,University of Sydney,Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lintzeris
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology / Q000523:psychology; D001315:Australia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D015577:Geriatric Assessment; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006707:Homes for the Aged / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D057187:Independent Living / Q000523:psychology / Q000706:statistics & numerical data; D008297:Male; D008403:Mass Screening; D009735:Nursing Homes / Q000706:statistics & numerical data; D011788:Quality of Life; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology / Q000523:psychology; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires