Recommended Screening Tools for Older Adults
Identifying substance use disorders (SUDs) in older adults requires tools tailored to this population's unique health profile and social circumstances. Because symptoms can often mimic age-related conditions, a specialized approach is crucial for early detection. The selection of a screening tool is typically guided by the specific substance in question, the clinical environment, and the required level of detail.
Short Michigan Alcohol Screening Test—Geriatric Version (SMAST-G)
The SMAST-G is highly recommended for screening alcohol use in older adults. As the first brief instrument specifically for this age group, it's a shortened version of the MAST.
- Geriatric-Specific Questions: Its 10 yes/no questions examine how alcohol affects an older person's life, covering emotional well-being, physical indicators of excessive use, and social interactions. This focus makes it more dependable for older adults compared to general tests.
- Scoring: Two or more “yes” answers suggest a potential alcohol issue requiring further evaluation.
- Accessibility: It can be self-administered or given by a clinician and is available in English and Spanish.
Screening, Brief Intervention, and Referral to Treatment (SBIRT)
The SBIRT model is a comprehensive strategy for identifying various substance use issues in older adults. It's a three-step process:
- Screening: Uses questionnaires to quickly assess risky use of alcohol, illicit drugs, prescription medications, and tobacco.
- Brief Intervention: Provides feedback and raises awareness through motivational conversations for those with positive screens but no dependence.
- Referral to Treatment: Directs patients requiring more extensive care to specialized services.
This model is adaptable for various healthcare settings.
Tobacco, Alcohol, Prescription medication, and other Substance use Tool (TAPS)
The TAPS tool is an efficient, two-part instrument that screens for a broad range of substances, including prescription drug misuse, which is common among older adults. It starts with a 4-item screen (TAPS-1) for past 12-month use of tobacco, alcohol, illicit drugs, and non-medical prescription drug use. A positive screen leads to a substance-specific assessment (TAPS-2). The electronic version provides a risk level for each substance, guiding clinical decisions.
Alcohol Use Disorders Identification Test—Consumption (AUDIT-C)
The AUDIT-C is a short, three-question version of the AUDIT used to screen for hazardous alcohol consumption in adults, including those 65 and older. It's effective for identifying binge drinking, and for older adults, a score of 3 or more is considered a positive screen, a lower threshold than for younger adults. While good for detecting risky drinking, it is less comprehensive than other tools regarding the overall impact of alcohol use.
Comparison of Screening Tools
| Feature | SMAST-G | SBIRT Model | TAPS Tool | AUDIT-C |
|---|---|---|---|---|
| Primary Focus | Alcohol misuse | Wide range of substances | Tobacco, alcohol, prescription, and illicit drugs | Alcohol consumption, particularly risky drinking |
| Target Population | Exclusively older adults | All adults, with adaptations for older adults | Adults, validated for use in primary care | All adults, with age-specific scoring for seniors |
| Screening Format | 10 yes/no questions | Multi-stage process with questionnaires | Two-phase tool (screener and brief assessment) | 3 questions |
| Speed | Quick and easy | Comprehensive, but initial screen is brief | Initial screen is brief, with follow-up assessment | Very quick |
| Strengths | Specifically validated for geriatric population, addresses common older adult issues. | Comprehensive approach, links screening to intervention. | Covers multiple substances in one tool, including prescription drugs. | Very fast, effective for detecting hazardous drinking. |
| Limitations | Only screens for alcohol, does not assess for other substances. | May require more training for full implementation. | Sensitivity for some less common drugs may be lower. | Only screens for alcohol. |
Conclusion
Selecting the most appropriate tool for screening substance use disorders in older adults depends on the specific circumstances. The Short Michigan Alcohol Screening Test—Geriatric Version (SMAST-G) is the preferred alcohol-specific tool, designed to capture the unique impacts of alcohol on this population. For screening multiple substances, the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model or the Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) Tool are effective. The Alcohol Use Disorders Identification Test—Consumption (AUDIT-C) offers a quick way to identify hazardous drinking. Clinicians should consider the individual's health, cognitive state, and comfort level when choosing a tool, aiming for early detection and intervention to improve their well-being.
Additional Considerations for Screening Older Adults
A respectful and non-judgmental approach is crucial when screening older adults, as stigma can hinder open communication. Awareness of polypharmacy and potential drug interactions is also important. Communication should be clear and adapted to the individual's needs.
- Co-occurring Conditions: Assess for co-occurring mental health disorders, such as depression or anxiety, alongside substance use.
- Involve Support Systems: Including family or caregivers, with consent, can provide valuable information and support.
- Trauma-Informed Care: A trauma-informed approach is helpful, as some older adults may have a history of trauma contributing to substance misuse.
A comprehensive geriatric assessment that includes SUD screening is best practice for promoting overall health in older adults.
