Delivery of evidence-based interventions for alcohol misuse in the emergency department is low

1. Alcohol misuse among older adults is common but the delivery of evidence-based interventions such as referral services and pharmacotherapy remains low in the emergency department (ED).

Evidence Rating Level: 2 (Good)

Alcohol misuse is a growing, under-recognized, and under-treated health condition in older adults (defined here as adults 55 years old and older), who often present to the ED not in overt intoxication, but for alcohol-related consequences such as falls, medication-related adverse events, and functional decline. Although EDs are increasingly implementing routine alcohol screening, there is a poor understanding of how this links to timely intervention. This retrospective cohort study of 11 EDs included 698,308 ED encounters among adults aged ≥ 55 years old. 39,912 (5.7%) screened positive for alcohol misuse, representing 27,423 unique patients. Approximately half (47%) were aged 55–64, 41% were aged 65–79, and 12% were aged ≥ 80 years. Overall, 58% of encounters involved male patients, with a more equal distribution by gender and older age. Men accounted for 58% of encounters, with gender differences narrowing with age. Social work and physical therapist involvement significantly increased with increasing Alcohol Use Disorders Identification Test – Consumption (AUDIT-C) scores. Naltrexone and acamprosate prescribing were rare (2.3% and < 1%, respectively) but increased significantly with increasing AUDIT-C scores. Despite increasing use of alcohol screening tools in the ED, delivery of evidence-based interventions such as referral services and pharmacotherapy remains uncommon.

Click here to read this study in Academic Emergency Medicine

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