在养老院居民中筛查危险饮酒：使用毛发中的乙基葡萄糖醛酸评估酒精使用障碍识别测试-饮酒问题当前截断值的有效性。
Screening for Hazardous Drinking in Nursing Home Residents: Evaluating the Validity of the Current Cutoffs of the Alcohol Use Disorder Identification Test-Consumption Questions by Using Ethyl Glucuronide in Hair.
机构信息
Department of Psychosomatic Medicine and Psychotherapy, Medical Park Chiemseeblick, Bernau-Felden, Germany.
Department of Psychology, University of Salzburg, Salzburg, Austria.
出版信息
Alcohol Clin Exp Res. 2017 Sep;41(9):1593-1601. doi: 10.1111/acer.13449. Epub 2017 Aug 14.
BACKGROUND
Because of physiological changes, elderly people are much more exposed to the adverse effects of alcohol. Therefore, hazardous drinking is defined at lower levels as compared to younger adults. This work aimed to evaluate the validity of the current cutoff levels of the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) questions to detect hazardous drinking in the elderly by using ethyl glucuronide in hair (HEtG).
METHODS
In a border region between Austria and Germany, 344 nursing home residents were included from 33 of the 107 nursing homes. Residents were asked to answer the AUDIT-C questions, hair samples were obtained, and nursing staff members were asked for their assessments of the residents' alcohol consumption. Hair samples were analyzed for HEtG using gas chromatography-mass spectrometry. Receiver-operating characteristic (ROC) curve analysis was performed to determine the validity of cutoff values for the AUDIT-C to detect an alcohol consumption of ≥10 g of alcohol/d.
RESULTS
A total of 11.3% of the nursing home residents (n = 344) drank ≥10 g of alcohol/d (4.9% >60 g of alcohol/d, 6.4% 10 to 60 g of alcohol/d, 88.7% <10 g of alcohol/d)). For the drinking limit of ≥10 g of alcohol/d, ROC curve analysis showed a balanced sensitivity and specificity, with an AUDIT-C cutoff of ≥4 for men (sensitivity: 70%, specificity: 83.6%; AUC = 0.823, CI = 0.718 to 0.928, p < 0.001) and ≥2 for women (sensitivity: 73.7%, specificity: 81.9%; AUC = 0.783, CI = 0.653 to 0.914, p < 0.001). Nursing staff (n = 274) underestimated alcohol consumption and evaluated 40% of the chronic-excessive alcohol consumers (>60 g of alcohol/d) as being abstinent.
CONCLUSIONS
Our data suggest that an AUDIT-C cutoff of ≥4 for men and ≥2 for women can be recommended to detect the consumption of ≥10 g of alcohol/d in the elderly. Because the nursing staff to a large extent underestimates the alcohol consumption among nursing home residents, further teaching of the staff, improvement of screening instruments for the elderly, and the use of objective biomarkers might be helpful for recognizing hazardous drinking and can thus help improve the quality of life of the elderly.
背景
由于生理变化，老年人更容易受到酒精的不良影响。因此，与年轻人相比，危险饮酒的定义水平更低。本研究旨在评估毛发中乙基葡萄糖醛酸（HEtG）检测老年人饮酒障碍识别测试-饮酒量（AUDIT-C）问题的现行截断值来检测危险饮酒的有效性。
方法
在奥地利和德国边境地区，从 107 家养老院中的 33 家养老院中纳入 344 名养老院居民。要求居民回答 AUDIT-C 问题，采集毛发样本，并请养老院工作人员评估居民的饮酒量。使用气相色谱-质谱法对毛发样本进行 HEtG 分析。采用受试者工作特征（ROC）曲线分析来确定 AUDIT-C 截断值检测饮酒量≥10 g/d 的有效性。
结果
共有 11.3%（n=344）的养老院居民（4.9% >60 g/d，6.4% 10-60 g/d，88.7% <10 g/d）饮酒≥10 g/d。对于饮酒量≥10 g/d 的饮酒限值，ROC 曲线分析显示均衡的敏感性和特异性，男性 AUDIT-C 截断值≥4（敏感性：70%，特异性：83.6%；AUC=0.823，CI=0.718-0.928，p<0.001），女性 AUDIT-C 截断值≥2（敏感性：73.7%，特异性：81.9%；AUC=0.783，CI=0.653-0.914，p<0.001）。护理人员（n=274）低估了饮酒量，并将 40%的慢性过量饮酒者（>60 g/d）评估为戒酒者。
结论
我们的数据表明，男性 AUDIT-C 截断值≥4，女性 AUDIT-C 截断值≥2，可用于检测老年人饮酒量≥10 g/d。由于护理人员在很大程度上低估了养老院居民的饮酒量，因此对护理人员进行进一步的教育、改善老年人的筛查工具以及使用客观的生物标志物可能有助于识别危险饮酒，从而提高老年人的生活质量。
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