to an increase in alcohol-induced physical, mental, and social problems.2) Problem drinking is a comprehensive concept combining at-risk drinking and alcohol use disorders. Specifically, at-risk drinking in elderly males refers to heavy drinking, where a male consumes > 7 standard drinks of alcohol per week, and binge drinking, where a male consumes > 3 alcoholic drinks per drinking session.3) Alcohol use disorders are defined as alcohol abuse or dependence according to psychiatric diagnostic criteria.4) Problem drinking in elderly people raises mental and physical issues. Heavy drinking exacerbates diseases of the digestive system such as cirrhosis, liver cancer, oral cancer, esophageal cancer, and pancreatitis. It also elevates the morbidity rates of cardiovascular diseases, such as atrial fibrillation, hypertension, and stroke, and mental diseases, such as alcohol dependence, depression, anxiety disorders, and suicidal ideation.5, 6) Thus, to solve alcohol-related problems in elderly drinkers, clinicians need to identify problem drinking at its early stages. In clinical settings, however, few cases of alcohol-related problems in elderly drinkers are identified. A study at a university hospital in the Netherlands found that only 33% of elderly alcohol abuse patients were identified by clinicians.7) Likewise, a three-hospital study in Australia reported that just 33% of these patients were discovered by clinical professionals.8) The percentages are remarkably lower compared with the discovery rate (60%) of alcoholism in patients below 60 years of age. In short, 2/3 of elderly drinking problems are not discovered by clinicians. Such low discovery rates may be due to several factors. First, elderly patients are more vulnerable to alcohol than are younger patients. That is, even when elderly people consume the same amount of alcohol as younger people do, their blood alcohol concentration is higher. Therefore, moderate drinking in young people may constitute heavy drinking in elderly people. This fact is often overlooked. Second, although 90% of elderly individuals with alcohol use disorders are treated for their physical problems, clinicians tend not to pay attention to drinking problems, which are non-specific and hard to identify.9) Third, negative attitudes toward alcoholism get in the way of making an accurate diagnoses. The stigma of alcoholism often leads alcoholics to drink in solitude, thereby missing the chance to be seen by clinicians at the appropriate time.10) Evaluating the validity of screening tools used for the Korean J Fam Med Young Il Ryou, et al: Alcohol-screening Instruments in Elderly Male Drinkers assessment of problem drinking in the elderly population is very important in terms of patient care in primary medical care settings. It is most desirable to diagnose at-risk drinking or alcohol use disorders through face-to-face interviews conducted by doctors. When such interviews are impossible, screening questionnaires completed by patients play an important role. Doctors may review the results of screening tests, suspect at-risk drinking or alcohol use disorders, and conduct further interviews for confirmation. Previous Korean studies based on the utility of alcohol questionnaires have focused largely on younger and older adults. Few studies have examined whether the screening tools are suitable for assessing drinking problems in the elderly. Accordingly, the present study attempted to assess the validity of three screening tools commonly used in primary care settings to identify problem drinking (at-risk drinking and alcohol use disorders) in elderly male drinkers. METHODS 1. Study Subjects Study subjects were 242 male drinkers aged ≥ 65 years who visited the department of Family Medicine at Chungnam National University Hospital between March and August 2009. Subjects agreed to study enrollment prior to filling out the questionnaires, and all participated based on informed consent. Those who were suspected of dementia and cognitive disorders were excluded. 2. Method 1) Diagnostic interview At-risk drinking and alcohol use disorders were assessed by means of diagnostic interviews conducted by family physicians. To assess at-risk drinking, the amount of alcohol consumption per drinking session and the average frequency of drinking per week were investigated. In this study, based on the criteria set forth by the National Institute on Alcohol Abuse and Alcoholism,3) heavy drinking of more than 7 standard drinks per week or binge drinking of more than 3 drinks per drinking session were defined as at-risk drinking. The standard drink refers to 14 grams of pure alcohol, equal to 1/4 of a bottle of 20% Soju, a Vol. 33, No. 3 May 2012 | 127