Brian Draper1, Nicole Ridley2, Carly Johnco3, Adrienne Withall4, Welkee Sim5, Matilda Freeman6, Erika Contini7, Nicholas Lintzeris8. 1. School of Psychiatry,University of NSW,Sydney,Australia. 2. Dementia Collaborative Research Centre,University of New South Wales,Sydney,Australia. 3. Centre for Emotional Health,Department of Psychology,Macquarie University,Sydney,Australia & Dementia Collaborative Research Centre,University of New South Wales,Sydney,Australia. 4. School of Public Health & Community Medicine,University of NSW,SydneyAustralia. 5. Department of Geriatric Medicine,Prince of Wales Hospital,Randwick,NSW,Australia. 6. Community Health Assessment and Therapy Team,Prince of Wales Hospital,Randwick,NSW,Australia. 7. 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. 8. 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.
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.
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.
Authors: Launette M Rieb; Zainab Samaan; Andrea D Furlan; Kiran Rabheru; Sid Feldman; Lillian Hung; George Budd; Douglas Coleman Journal: Can Geriatr J Date: 2020-03-30