Young Il Ryou, et al: Alcohol-screening Instruments in Elderly Male Drinkers elderly men. This was lower than the score of 15 points presented in the previous study12) based on adult males of all ages. This may be attributable to the same phenomenon as the cut-off score in screening for at-risk drinking. In short, it seems necessary to set lower cut-off scores on the AUDIT in elderly men than those used for the general adult male population. The validity of the SMAST-G questionnaire has never been studied in Korea to the best of our knowledge. Regarding screening for alcohol use disorders in elderly men, the results of the present study fit well with those of the earlier study by Morton et al.,18) which reported that the SMAST-G exhibited 69.8% sensitivity, 80.5% specificity, and an AUROC of 0.84 based on 120 veterans aged ≥ 65 years. However, Morton et al.18) concluded that the SMAST-G was the best tool among the AUDIT, CAGE, and SMAST-G, based on their subjects. The present study, in contrast, found that the AUDIT was more useful than the SMAST-G. This difference may be partly due to items included in the DSM-IV criteria for alcohol abuse, such as repeated problems in social relationships and legal issues, which were not stressed in the DSM-III criteria. The cut-off score of 2 points for the SMAST-G for use in screening for at-risk drinking in elderly men in the current study is consistent with cut-off scores reported previously.15,19) Also, 4 points, identified as the optimal cut-off score for use in screening for alcohol use disorders in our study, is thought to be similar to 5 points presented by previous studies.20-22) The CAGE questionnaire has a small number of items and is simple and easy to use in outpatient settings, although it proved less applicable to the elderly population in the current study. In this study, the CAGE questionnaire was found to have 60% sensitivity and 68% specificity in screening for at-risk drinking and 87% sensitivity and 63% specificity in screening for alcohol use disorders in this elderly population. A previous domestic study by Park et al.14) on the validity of the CAGE in adult male drinkers found 76.1% sensitivity and 90.0% specificity in screening for alcohol use disorders. Compared with the previous study, the sensitivity was higher and the specificity was lower in the present study, which seems attributable to demographic differences in the subjects. In the study by Park et al.,14) subjects aged ≥ 60 years accounted for 5% of the entire sample, whereas the present study dealt entirely with men aged ≥ 65 years only. The cut-off score of 2 points for the CAGE questionnaire in the current study as the 132 | Vol. 33, No. 3 May 2012 reference score in screening for alcohol use disorders in elderly men fits well with the cut-off score suggested by Park et al.;14) however, this score is 1 point higher than that presented by Jones et al.23) This seems partly attributable to the fact that people in the East tend to hold more liberal viewpoints on drinking, especially drinking by elderly people, than do those in the West. Some limitations of the present study should be addressed. First, the authors’ efforts to include drinkers as subjects may have resulted in a bias toward heavy and binge drinkers. This may have led to the improper representation of general socio-demographic characteristics. Second, eight subjects (3.3%) were patients with alcohol abuse, and 38 subjects (15.7%) had alcohol dependence. Thus, fewer subjects abused alcohol than were alcohol dependent. In interpreting the results, it should be noted that the DSM-IV- TR criteria for alcohol abuse that emphasizes “drinking even in cases of role-fulfillment disorder including absence and failure in duty and in physically dangerous situations such as drunken driving and operating machines” may not be applicable to elderly people, who are socially and occupationally less interactive. The fact that the subjects were elderly people (71.8 years old mean age) and 77.7% of the subjects were unemployed in this study also supports the above-mentioned points. In conclusion, the present study investigated the utility of three alcohol-screening tools, the AUDIT, SMAST-G, and CAGE questionnaires, in screening for drinking problems in elderly men and found that the AUDIT proved the most useful in screening for at-risk drinking and alcohol-use disorders in elderly Korean men. CONFLICT OF INTEREST No potential conflict of interest relevant to this article was reported. REFERENCES 1. Statistics Korea. The aged statistics 2007 [Internet]. Daejeon: Statistics Korea; 2007 [cited 2012 May 16]. Available from: http://kostat.go.kr/portal/korea/kor_nw/2/1/index. board?bmode=read&aSeq=55818. 2. Buchsbaum DG, Buchanan RG, Welsh J, Centor RM, Schnoll Korean J Fam Med