Screening for Drinking Disorders in the Elderly Using the CAGE Questionnaire

OBJECTIVE: To assess the performance of the CAGE questionnaire in identifying elderly medicine outpatients with drinking problems. DESIGN: Cross-sectional design, with the alcohol module of the Diagnostic Interview Schedule as the criterion standard. SETTING: The outpatient medical practice of an urban university teaching hospital. PATIENTS: Consecutive patients 18 years or older who signed a consent form approved by the university's institutional review board. For this study, 323 patients greater than or equal to 60 years old. MAIN OUTCOME MEASURES: Sensitivity, specificity, receiver operating characteristics (ROC) curve and positive predictive value for CAGE scores of 0-4 for patients 60 years or older. RESULTS: Thirty-three percent of the sample group met study criteria for a history of drinking problems, including 63% of the male patients and 22% of the female patients. The sensitivity and specificity for a cut-off score of one for all patients was 86% and 78%, respectively, and 70% and 91% for a cut-off of two. The calculation of the area under the ROC curve was .86, and the positive predictive value of CAGE scores of 0-4 were 33%, 66%, 79%, 82%, and 94%, respectively. The predictive value for any score was higher in males than females, reflecting the higher prevalence of problems in the male population. CONCLUSIONS: The CAGE can effectively discriminate elderly patients with a history of drinking problems from those without such a history. The chosen cut-off score should consider the prevalence of drinking problems in the population being tested.