Screening older adults for alcohol use in orthopaedic care: Healthcare team perspectives, current practices, and barriers.

BACKGROUND

Alcohol use disorder (AUD) is rising among older adults at a concerning rate and is considered an emerging public health problem. Despite this, validated screening is infrequently implemented in orthopaedic settings despite evidence that alcohol use negatively affects fracture risk and postoperative outcomes. Limited knowledge, training, and workflow integration may contribute to inconsistent practices. The purpose of this study is to evaluate orthopaedic healthcare professionals' perceptions of older adult alcohol use, current screening behaviors, familiarity with validated tools, and barriers and supports relevant to implementing evidence-based screening practices.

METHODS

Seventy-five medical professionals from a university-based orthopaedic clinic completed questionnaires during clinical staff meetings. Measures included perceptions of older adult drinking, attitudes toward screening, current screening practices, familiarity with validated instruments, and implementation outcomes. Open-ended items assessed barriers and needed support. Descriptive statistics summarized quantitative responses, and ANOVAs examined group differences. Two independent coders conducted thematic analysis of qualitative data.

RESULTS

Most participants agreed that alcohol affects orthopaedic outcomes and endorsed screening older adults, but fewer than 5% reported using validated tools. Physicians reported higher screening rates than clinical or administrative staff, though overall familiarity with screeners, including older-adult-specific measures, was low. Barriers included limited time, workflow constraints, training gaps, uncertainty regarding tool selection, and variable perceptions of role relevance. Participants identified needs for standardized workflows, education, and clear referral pathways.

CONCLUSIONS

Despite broad support for alcohol screening, validated tools are rarely used in orthopaedic practice. Addressing workflow integration, training deficits, and tool familiarity may enhance implementation, improve detection of risky alcohol use, and support better outcomes for older adult orthopaedic patients.