Are There Differences Between Older Persons Who Screen Positive on the CAGE Questionnaire and the Short Michigan Alcoholism Screening Test-Geriatric Version?

OBJECTIVES: To determine (1) the extent of agreement between the CAGE (acronym for cut down, annoyed by criticism, guilty about drinking, eye‐opener drinks) and the Short Michigan Alcoholism Screening Test—Geriatric Version (SMAST‐G) in identifying older persons who may have possible alcohol use disorders (AUDs) and (2) whether persons identified as having possible AUDs by each of these screening measures differ in their drinking, demographic, or health‐related characteristics. DESIGN: Secondary analysis of a cross‐sectional study using data from a self‐administered mailed survey sample. SETTING: Three organizations were surveyed: (1) members of the American Association of Retired Persons and, in southern California, (2) managed care enrollees in a large medical group and (3) attendees of a community‐based senior health center. PARTICIPANTS: One thousand eight hundred eighty‐nine persons aged 55 and older completing a health risk appraisal for older persons (Health Risk Appraisal for the Elderly (HRA‐E)). MEASUREMENTS: The HRA‐E included items on drinking behaviors (including amount of alcohol use, the CAGE, and the SMAST‐G) and health and demographic characteristics. RESULTS: Twenty‐six percent of all persons screened positive on the CAGE or the SMAST‐G. Fewer than half of all persons screening positive on either the CAGE or the SMAST‐G, screened positive on both measures. Among current drinkers, persons screening positive on the SMAST‐G alone drank less than persons screening positive on the CAGE alone, and these persons drank less than those screening positive on both the SMAST‐G and the CAGE. More men screened positive on the CAGE alone than on the SMAST‐G alone. CONCLUSION: Fewer than half of persons screening positive on either the CAGE or the SMAST‐G screened positive on both measures, suggesting that these instruments may be capturing different aspects of unsafe drinking. A screening strategy employing both brief measures may identify more AUDs among older persons having differing demographic and health characteristics.