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How do you effectively evaluate the elderly for alcohol use disorder?

Moronkeji Fagbemi, MD, FASAM
Cleveland Clinic Journal of Medicine August 2021, 88 (8) 434-439; DOI: https://doi.org/10.3949/ccjm.88a.20123

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Tables

  • TABLE 1

    Presentation of alcohol problems in the elderlya

    Anxiety
    Poor hygiene, urinary or fecal incontinence
    Malnutrition
    Confusion, memory loss, dementia, or delirium
    Falls
    Marital problems
    Sleep problems
    Depression or mood swings
    Financial problems
    Seizures (new-onset, idiopathic)
    Worsening of chronic medical problems (hypertension, diabetes, heart failure)

    • ↵a Note: Crime, antisocial, and substance-seeking illegal behaviors are not common in this group.

  • TABLE 2

    Short Michigan Alcoholism Screening Test—Geriatric Version (SMAST-G)

    Please answer yes or no to the following questions:

    1. When talking with others, do you ever underestimate how much you drink?

    2. After a few drinks, have you sometimes not eaten or been able to skip a meal because you didn’t feel hungry?

    3. Does having a few drinks help decrease your shakiness or tremors?

    4. Does alcohol sometimes make it hard for you to remember parts of the day or night?

    5. Do you usually take a drink to relax or calm your nerves?

    6. Do you drink to take your mind off your problems?

    7. Have you ever increased your drinking after experiencing a loss in your life?

    8. Has a doctor or nurse ever said they were worried or concerned about your drinking?

    9. Have you ever made rules to manage your drinking?

    10. When you feel lonely, does having a drink help?

    Extra question (asked, but not calculated in the final score): Do you drink alcohol and take mood or mind-altering drugs, including prescription tranquilizers, prescription sleeping pills, prescription pain pills, or any illicit drugs?
    Scoring: 1 point for each “yes” answer, and total the responses. A score of 2 or more points indicates an alcohol problem, and a brief intervention should be conducted.

    • Adapted from reference 17.

  • TABLE 3

    Assessment of alcohol use disorder in the elderlya

    Previous diagnosis of alcohol-use disorder
    Drinking patterns, physiologic dependence, withdrawals
    Presence of intoxication
    Neuropsychiatric comorbidities or manifestations including suicidal ideation
    Medical comorbidities and complications including chronic pain; current medications
    Psychosocial evaluation including housing, dietary issues, finances, legal issues, sociability, family
    Prior treatment, including pharmacotherapy: success, failure, relapse, participation in support groups
    Patient’s level of motivation to change

    • ↵a Assessment should include screening, a thorough medical and psychosocial history, physical examination, and appropriate laboratory tests.

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