Health Education System With Older Primary Care Patients
Background: This study evaluated the feasibility of a combined alcohol-screening and health education system for elderly patients
Methods: The Computerized Alcohol-Related Problems Survey (CARPS) was evaluated in primary care practices among 106 current drinkers, 60 years and older. The CARPS contains (1) a self-administered screening survey; (2) software to scan or hand-enter survey responses; (3) software to process data and electronically generate reports of patients' drinking risks; (4) health education; and (5) a database useful for clinical and quality improvement purposes.
Results: Nearly all study participants were able to complete the CARPS while waiting for a prescheduled appointment with their physician. There were 44% of patients who were hazardous and 9% who were harmful drinkers. About 20% of men and 26% of women were binge drinkers. Most (85%) patients agreed that alcohol is an important topic, 67% reported learning new information, 78% had never discussed drinking with a physician, and 31% intended to do so. After reviewing CARPS data, physicians concluded that alcohol use in the elderly is an important quality improvement topic.
Conclusions: Combined screening and health education systems appear feasible for use in practice if they deal with pertinent health problems such as alcohol use. Their data can encourage discussions between physicians and patients and might be used for quality improvement activities.

Alcohol-related problems in the elderly are an important public health concern. Population-based studies, using various methods and diverse settings, estimate the prevalence of current alcohol-related problems in older Americans to range from 2% to 22%, with between 4% and 10% of older Americans actively alcoholic. A 1989 study of Medicare claims data found the rate of alcohol-related hospitalizations among persons 65 years of age and older to be similar to that for myocardial infarction. As the elderly population grows, the absolute number of older adults with alcohol-related problems will also rise, contributing to the magnitude of this public health issue.

Older adults can experience adverse health effects even at relatively low levels of consumption because of age-related physiologic changes and the interaction between alcohol, declining health, medication use, and diminishing functional status. Aging is associated with decreases in body water volume and lean body mass; thus, older people reach higher peak alcohol levels at lower levels of use. Relatively low consumption levels can adversely affect chronic medical problems common in older persons, such as hypertension and diabetes, and can increase the difficulty of managing them. More than 75% of older adults regularly use medications (such as nonsteroidal anti-inflammatory, antihypertensive, and antidepressant agents), many of which have the potential to interact adversely with alcohol.

Despite the prevalence of problematic alcohol use in the elderly, primary care physicians do not often screen their patients for alcohol-related risks or problems. Among the major reasons for not doing so is that most of the available screening measures have been designed to detect abusive and dependent drinking or alcoholism. They are probably less applicable to the general needs of the community-dwelling elderly, whose risks occur primarily at relatively low consumption levels, although some older adults are known for episodic heavy drinking For instance, the CAGE questionnaire, one commonly used screening measure, can successfully determine which older adults are suffering from alcohol abuse or dependence, but it does not provide data on the relation between alcohol and health, medication use, and functional status. The CAGE also performs poorly in detecting heavy or binge drinkers. The Alcohol Use Disorders Identification Test (AUDIT) is another commonly used screening measure, which has been shown to detect hazardous and harmful drinking in younger people, but it is not designed to provide information on alcohol use and health or on nonhazardous drinking. Information on nonhazardous drinking can be clinically important in light of recent studies showing that in some persons, light consumption (ie, one or two drinks daily) has beneficial effects on cardiovascular functioning, stroke prevention, and all-cause mortality.

In this article we report the feasibility of using the Computerized Alcohol-Related Problems Survey (CARPS) system, a screening and health education system for older adults. A feasible screening and health education system pertaining to alcohol use in the elderly has the potential for alleviating this growing public health problem. To be feasible, patients must agree that the topic of alcohol use is important and that they learned new information about it. Also, patients should find the system is easy to use and that educational messages are pertinent and helpful in initiating behavior change. Finally, a feasible system must fit well into a busy community-based practice.