The performance and feasibility of three brief alcohol screening tools in a senior population
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Screening is the first step in identifying and treating alcohol-related problems among the senior population. This study was designed with two purposes. The first was to cross-validate the Senior Alcohol Misuse Indicator (SAMI) with two commonly used screening tools - the CAGE and the Shortened Michigan Alcoholism Screening Test – Geriatric version (SMAST-G). The second purpose was to examine the feasibility of using these tools within a front-line health care worker’s clinical protocol. The effectiveness of each screening tool was assessed by calculating the sensitivity, specificity, and the area under the receiver operating characteristic (AUROC) for each screening tool with a sample of seniors recruited from clinical and community sources (N=87). Participants were classified into different types of drinker with a structured clinical interview (i.e., the Structured Clinical Interview for the DSM-IV and a medical history, including medication list). Seven problem drinkers, 36 at-risk drinkers, 25 non-problem drinkers, and 19 non-drinkers were identified. Among the three screening tools, the SAMI had the highest sensitivity (83.72%) in identifying at-risk drinkers and problems drinkers and best overall performance with the greatest AUROC (0.710), whereas the SMAST-G had the highest specificity (95.45%) in ruling out an alcohol-related problem among participants classified as non-problem drinkers and non-drinkers. Six outreach mental health care workers tested each screening tool at least three times with their senior clientele and rated each tool on a number of characteristics. An ANOVA and post-hoc analyses using the Least Significant Difference (LSD) compared these ratings among the three screening tools. The SMAST-G and CAGE were cited as the easiest to score (p=0.002), while the SMAST-G was cited as the screening tool providing the most clinical information (p=0.047) and the most comprehensive (p=0.019) of the three tools. These results point to the overall effectiveness of the SAMI and the user-friendliness of the SMAST-G as appropriate screening tools for identifying alcohol-related problems among the senior population. Future studies may further examine these two screening tools among as-yet-untested clinical populations (i.e., geriatric mental health outreach patients, cognitively impaired, collateral informants) and how to improve screening tool usage among health care providers.