Screening for Alcohol Use Disorders in the Nursing Home

OBJECTIVES: To determine the prevalence of Alcohol Use Disorders (AUDs) among residents of a Veterans Affairs (VA) nursing home (NH) using DSM‐III‐R criteria for alcohol abuse and dependence, and to examine the demographic variables associated with AUDs among NH residents. A third objective was to assess the sensitivity, compared with DSM‐III‐R criteria, of three screening tests for AUDs in the NH: the CAGE, the MAST‐G, and the two‐question instrument developed by Cyr and Wartman. DESIGN: A cross‐sectional design, with DSM‐III‐R criteria determined by the alcohol module of the Diagnostic Interview Schedule (DIS) as the criterion standard. PATIENTS: Patients older than age 50 admitted consecutively to a VA NH, n = 117. MAIN OUTCOME MEASURES: Sensitivities, specificities, positive predictive values for the CAGE, MAST‐G, and Cyr and Wartman Screening questionnaires; receiver operating characteristic (ROC) curves for the CAGE and MAST‐G. MAIN RESULTS: Forty‐nine percent of study participants met DSM‐III‐R criteria for lifetime alcohol abuse or dependence (18% active, 31% inactive). The sensitivities and specificities of the three screening questionnaires were as follows: CAGE‐82% and 90%; MAST‐G‐93% and 65%; Cyr and Wartman‐70% and 92%, respectively. The area under the ROC curve was 0.94 for the CAGE and 0.90 for the MAST‐G. CONCLUSIONS: The prevalence of lifetime alcohol abuse and dependence was high in this VA NH population. Both the CAGE and MAST‐G are sensitive to AUDs in this setting. The areas under the ROC curves were not significantly different and indicate both tests discriminated well between NH residents with and without AUDs. 1995 The American Geriatrics Society