Which screening test for alcohol consumption is best associated with ‘at risk’ drinking in older primary care attenders?

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AimsTo measure the criterion validity of the AUDIT (Alcohol Use Disorders Screening Test) and SMAST-G (Short Michigan Alcoholism Screening Test-Geriatric Version) in older people in primary care against Royal College of Psychiatrists’ criteria for ‘at risk’ drinking, and to compare older ‘at risk’ drinkers in primary care with normal drinkers.MethodSurgery attendees in primary care in South East London aged over 65 years completed a questionnaire including the AUDIT and SMAST-G, and questions about alcohol consumption. Age, sex, marital status and ethnicity were recorded. Receiver operating characteristic (ROC) analysis was carried out on the AUDIT and SMAST-G questionnaires against drinking in excess of Royal College guidelines. Those drinking above and below Royal College guidelines were compared.ResultsA total of 500 participants completed questionnaires; 33 (6.6%) admitted drinking above Royal College guidelines: 23 (4.6%) were AUDIT positive and 52 (10.4%) SMAST-G positive. ‘At risk’ drinking was associated with being male, younger and not being widowed. The area under the curves was 0.96 for the AUDIT and 0.83 for the SMAST-G, indicating significantly better criterion validity for the former. Best cut-off points for men (5/6) and women (3/4) were lower than for younger people.ConclusionsThe AUDIT performed significantly better than the SMAST-G against UK Royal College of Psychiatrists’ guidelines on safe levels of alcohol consumption in this sample of 500 primary care attendees aged over 65 years. Although the AUDIT was not designed specifically as a screening questionnaire for ‘at risk’ drinking in older people, our study suggests that it performs well in older adult populations using different cut-off points for men and women.

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