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      Hazardous Drinking Prevalence and Correlates in Older New Zealanders: A Comparison of the AUDIT-C and the CARET

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          Abstract

          Objectives: The study compared the proportion of older adults identified as drinking hazardously based on the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) with the older adult-specific Comorbidity Alcohol Risk Evaluation Tool (CARET) and investigated whether sociodemographics, comorbidities, health, medication use, and alcohol-related risk behaviors explained discrepancies between the screens in classification of hazardousness. Method: The AUDIT-C and the CARET were administered to 3,673 adults aged 55 to 89 years. Classification agreement between the screens was evaluated using Cohen’s kappa. Hazardous drinking groups were compared using logistic regression. Results: Analysis indicated moderate agreement between the screens. Drinkers classified as “hazardous on the CARET only” consumed less alcohol, but were more likely to drink-drive. Introducing a drink-driving criterion into the calculation of hazardousness on the AUDIT-C substantially decreased the classification discrepancy between the measures. Discussion: Standard screening can be improved by investigating comorbidities, medication use, and alcohol-related risk behaviors in those initially identified as nonhazardous drinkers.

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          Most cited references 22

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          Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness.

          The U.S. Preventive Services Task Force (USPSTF) has recommended screening and behavioral counseling interventions in primary care to reduce alcohol misuse. This study was designed to develop a standardized rating for the clinically preventable burden and cost effectiveness of complying with that recommendation that would allow comparisons across many recommended services. A systematic review of the literature from 1992 through 2004 to identify relevant randomized controlled trials and cost-effectiveness studies was completed in 2005. Clinically preventable burden (CPB) was calculated as the product of effectiveness times the alcohol-attributable fraction of both mortality and morbidity (measured in quality-adjusted life years or QALYs), for all relevant conditions. Cost effectiveness from both the societal perspective and the health-system perspective was estimated. These analyses were completed in 2006. The calculated CPB was 176,000 QALYs saved over the lifetime of a birth cohort of 4,000,000, with a range in sensitivity analysis from -43% to +94% (primarily due to variation in estimates of effectiveness). Screening and brief counseling was cost-saving from the societal perspective and had a cost-effectiveness ratio of $1755/QALY saved from the health-system perspective. Sensitivity analysis indicates that from both perspectives the service is very cost effective and may be cost saving. These results make alcohol screening and counseling one of the highest-ranking preventive services among the 25 effective services evaluated using standardized methods. Since current levels of delivery are the lowest of comparably ranked services, this service deserves special attention by clinicians and care delivery systems.
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            Alcohol use disorders in elderly people--redefining an age old problem in old age.

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              AUDIT and its abbreviated versions in detecting heavy and binge drinking in a general population survey.

              The aim of this study was to define optimal cut points for the Alcohol Use Disorders Identification Test (AUDIT) and its abbreviated versions (AUDIT-C, AUDIT-QF, and AUDIT-3), and to evaluate how effectively these questionnaires detect heavy drinking in the general population. The study population consisted of a sub-sample of the National FINRISK Study. A stratified random sample of 3216 Finns, aged 25-64, was invited to a health check. Of these, 1851 (57.6%) completed the AUDIT and participated in person in the Timeline Followback (TLFB) interview regarding their alcohol consumption. The TLFB-based definition of heavy drinking was used as a primary gold standard (for males > or =16 standard drinks average in a week or > or =7 drinks at least once a month; for females, respectively, > or =10 and > or =5 drinks). Areas under receiving operating characteristics curves (AUROCs), sensitivities and specificities were used to compare the performance of the tests. The AUDIT and its abbreviated versions are valid for detecting heavy drinking also in a general population sample. However, performance seems to vary between the different versions and accuracy of each test is achieved only by using tailored cut points according to gender. The AUDIT and AUDIT-C are effective for both males and females. The optimal cut points for males were found to be >/=7 or 8 for AUDIT and > or =6 for AUDIT-C. Among females the optimal cut points were found to be > or =5 for AUDIT and > or =4 for AUDIT-C. The study also indicates that AUDIT-QF among females and AUDIT-3 among males are relatively effective. The cut points for detecting all heavy drinkers (including binge drinkers without exceeding weekly thresholds) were lower than for detecting heavy drinkers excluding those who are only binge drinkers.
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                Author and article information

                Contributors
                (View ORCID Profile)
                Journal
                Journal of Aging and Health
                J Aging Health
                SAGE Publications
                0898-2643
                1552-6887
                December 2019
                August 27 2018
                December 2019
                : 31
                : 10
                : 1770-1789
                Affiliations
                [1 ]Massey University, Palmerston North, New Zealand
                [2 ]The University of Auckland, New Zealand
                [3 ]University of California, San Diego, CA, USA
                [4 ]Swansea University, UK
                [5 ]University College London, UK
                [6 ]Alcohol Research Group/Public Health Institute, Emeryville, CA, USA
                [7 ]National Research Council, Neuroscience Institute, Padova, Italy
                [8 ]World Health Organization, Geneva, Switzerland
                [9 ]University of Newcastle, Callaghan, Australia
                [10 ]University of Oslo, Norway
                [11 ]Johns Hopkins University, Baltimore, MD, USA
                Article
                10.1177/0898264318794108
                © 2019

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