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Screening for alcohol and substance use for older people in geriatric hospital and community health settings

Published online by Cambridge University Press:  23 September 2014

Brian Draper ,
Nicole Ridley ,
Carly Johnco ,
Adrienne Withall ,
Welkee Sim ,
Matilda Freeman ,
Erika Contini  and
Nicholas Lintzeris
Brian Draper*
Affiliation:
School of Psychiatry, University of NSW, Sydney, Australia
Nicole Ridley
Affiliation:
Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia
Carly Johnco
Affiliation:
Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia & Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia
Adrienne Withall
Affiliation:
School of Public Health & Community Medicine, University of NSW, SydneyAustralia
Welkee Sim
Affiliation:
Department of Geriatric Medicine, Prince of Wales Hospital, Randwick, NSW, Australia
Matilda Freeman
Affiliation:
Community Health Assessment and Therapy Team, Prince of Wales Hospital, Randwick, NSW, Australia
Erika Contini
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
Nicholas Lintzeris
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
*
Correspondence should be addressed to: Brian Draper, Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Barker Street, Randwick, NSW 2031, Australia. Phone: +61-2-93823753; Fax: +61-2-93823762. Email: b.draper@unsw.edu.au.
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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.

Method:

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.

Keywords

Alcoholhealthcare systemssubstance abusescreening
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 1 , January 2015 , pp. 157 - 166
Copyright
Copyright © International Psychogeriatric Association 2014 

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