Alcoholism screening questionnaires: are they valid in elderly medical outpatients?

Thomas V Jones,Bahar Farani-Enayat,Byron A Lindsey,Pamela Yount,Rebecca Soltys

doi:10.1007/bf02598284

Abstract

To assess the validity of the CAGE (cut down, annoyed, guilty feelings, eye-opener) questionnaire and the Michigan Alcoholism Screening Test (MAST) in distinguishing between elderly patients with and without alcohol abuse or dependence disorders. A cross-sectional study, in which patients were interviewed with a "gold standard," the alcohol module of the Revised Diagnostic Interview Schedule (DIS-III-R), and two screening questionnaires: the CAGE and the MAST. The study was conducted in the outpatient medical practice of a university teaching hospital. All English-speaking continuity patients 65 years of age or older able to participate were eligible; complete data were available for 154 (91%) of the 170 people who agreed to participate. Sixty-seven patients (44%) were active drinkers, whereas 87 (56%) reported abstinence. Twenty-five patients (16%) met Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) criteria for alcohol abuse or dependence. A CAGE score of 2, the conventional cutoff point, had a sensitivity and a specificity of 48% and 99%, respectively. A MAST score of 5, the originally recommended cutoff point, had a sensitivity and a specificity of 52% and 91%, respectively. The areas under the receiver operating characteristic (ROC) curves were 0.91 for the CAGE and 0.61 for the MAST. The CAGE and the MAST were both characterized by low sensitivities at conventional cutoff points, but the CAGE was significantly more effective than the MAST in discriminating between elderly medical outpatients with and without alcohol abuse or dependence.

Highlights

A myocardial infarction (MI) (‘heart attack’) can be intensely stressful, and the impact of this event can leave patients with clinically significant post-MI stress symptoms
Even cardiac patients with less clinically obvious, mild to moderate low mood, stress and anxiety are at risk of adverse outcomes, with evidence indicating that it is not the case, that these elements merely co-exist alongside the pathophysiological effects, but rather that these mild to moderate elements and adverse cardiovascular reactions may share a common underlying pathophysiological mechanism [12,13]
Design The review will evaluate fear of recurrence (FoR) screening tools and methods of measurement in different clinical populations

Summary

Introduction

A myocardial infarction (MI) (‘heart attack’) can be intensely stressful, and the impact of this event can leave patients with clinically significant post-MI stress symptoms. Significant post-MI stress symptoms are thought to be present in up to 12.5% (one in eight) patients, and evidence indicates that the post-trauma stress may increase patients risk for subsequent cardiac events and mortality [9]. To date, few tools are available which allow cardiology service providers to screen and identify MI survivors for specific thoughts or beliefs that can trigger modifiable stress responses. In other life-threatening illnesses such as cancer, ‘fear of illness recurrence’ has been identified as a key trigger of stress in patients and screening tools to identify this specific stressor have been developed [14,15,16,17]

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