25 Jun Number of “Oldest-Old” Veterans Entering Health Care System Rising Dramatically

MedicalResearch.com Interview with:
Jinmyoung Cho, PhD
Assistant Investigator
Center for Applied Health Research
Baylor Scott & White Health
Temple, TX 76508
Texas A&M Health Science Center
College Station, Texas

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Early life-course transition experiences to the adult years result in continuing consequences for health in later life. Many veterans have encountered life-threatening environments while they were on military service leading to a higher incidence of physical and mental diseases; greater comorbidity profiles in veterans contribute to higher mortality rate compared to non-veterans.

With increased life expectancy and demographic shifts in our population, the proportion of oldest-old adults, aged over 80 years, continues to increase. The publicly funded Veterans Health Administration (VHA) must care efficiently and effectively for its increasing population of veterans, who are older, sicker, and socioeconomically disadvantaged relative to non-veterans.

Given the large number of veterans over age 80 and the increasing emphasis on managing the aging process, it is important to identify associations between healthcare utilization and survival for VHA’s oldest patients.

We identified protective and risk factors associated with mortality by age group. During a 5-year follow-up period, 44% of patients aged 85 years and over died with survival rates of 59% for 80’s, 32% for 90’s and 15% for 100’s. In the multivariable model, protective effects for veterans 80-99 were female sex, minority race or ethnicity, being married, having certain physical and mental diagnoses (e.g., hypertension, cataract, dyslipidemia, posttraumatic stress disorder, bipolar disorder), urgent care visits, invasive surgery, and few (one to three) prescriptions. Risk factors were lower VHA priority status, physical and mental conditions (e.g., diabetes, anemia, congestive heart failure, dementia, anxiety, depression, smoking, substance abuse disorder), hospital admission, and nursing home care. For those in their 100s, married status, smoking, hospital admission, nursing home care, invasive surgery, and prescription use were significant risk factors; only emergency department (ED) use was protective.

MedicalResearch.com: What should readers take away from your report?

Response: Our findings suggest that healthcare utilization patterns correlate with survival among oldest-old veterans. Three-quarters of a million oldest-old veterans utilize the VHA in a single year. Furthermore, a couple of variables turned out to be protective factors for death by age group. For example, visiting the ED was protective against death in the oldest-old; and diagnoses of hypertension and dyslipidemia were negatively related to mortality among 80’s and 90’s groups. This indicates that detecting early signs of chronic conditions and early engagement on diseases from healthcare services is strongly associated with survival and longevity.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: We were not able to consider the survivorship effect (i.e., a selection process such that those who remain survived or live longer tend to be healthier than those who died). Patients included in this study could have been functioning better on physical and mental health indicators than those who had died earlier. In other words, the sickest had already died and the survivors were able to cope either without dangerous medications (e.g., psychotherapy alone) or had milder cases. A longitudinal design can differentiate selective survivorship effects related to longevity and enhance our understanding of trajectories in the relationship between healthcare utilization and mortality.

MedicalResearch.com: Is there anything else you would like to add?

Response: Again, with increased life expectancy and demographic shifts in our population, the proportion of oldest-old adults, aged over 80 years, continues to increase. Nevertheless, compared to other age group of patients, healthcare services have rarely paid attention to the oldest-old patients. Providing integrative healthcare services and early engagement in treatment of aging related chronic diseases would contribute to healthy aging and longevity.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Protective and Risk Factors for 5-Year Survival in the Oldest Veterans: Data from the Veterans Health Administration
J Am Geriatr Soc 64:1250–1257, 2016

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on June 25, 2016 by Marie Benz MD FAAD