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BACKGROUND/RATIONALE:
An estimated 500,000 or 16.5% of enrolled veterans over 65 years of age have difficulty performing basic and instrumental activities of daily living (ADL). Approximately 170,000 veterans use VA long-term care services, and the number of older and disabled veterans is expected to increase in coming decades. Additionally, disability is a likely trigger to use of VA medical services by veterans who may previously have received their care outside the VHA.
OBJECTIVE(S):
The proposed project bridges two lines of scientific investigation research on disability in aging and on veterans’ use of health services in and outside of the VHA -- to address the following research questions:
1. Are older veterans at increased risk of incident or new-onset disability compared to older non-veterans? Do older veterans who develop incident disability differ in their likelihood of recovery compared to older non-veterans?
2. What is the role of chronic conditions in the development of incident disability in veterans and in non-veterans?
3. Do veterans and non-veterans differ in their use of specific types of health services after developing incident disability? Is there racial variation in the use of specific types of health services after incident disability among veterans and non-veterans? How is use of healthcare services following incident disability associated with quality of care?
4. Among veterans, is incident disability associated with new use of VA medical services?
5. Among veterans with incident disability, does use of specific health services differ depending on whether the veteran is enrolled for VA services?
METHODS:
This is an observational cohort study. We merged data from the 1996-2002 Medicare Current Beneficiary Survey (MCBS), a continuous, longitudinal survey of a representative rotated sample of 12,000 Medicare beneficiaries, with data from the VA’s National Patient Care Database (NPCD) to identify a sample of 6637 males, age 65 and older, with no disability when they entered the MCBS. The cohort includes 4432 (67%) veterans. The MCBS provides data on disability over time, medical conditions, other baseline demographic characteristics and longitudinal data on non-VHA health care use from linked Medicare claims. VHA use comes from the NPCD. Our outcomes were death and incident disability any time after entry in the MCBS. We estimated discrete time hazard models with follow up from 1 to 3 years, adjusting for baseline age, race/ethnicity, education, income, secondary insurance, self-reported health, smoking, comorbid conditions, instrumental ADLs, hospitalization in past 12 months, use of antidepressants, use of anxiolytics, use of antipsychotics, follow-up year and veteran status.
FINDINGS/RESULTS:
Our initial analyses have focused on the risk of incident disability and death in veterans compared to non-veterans. Overall, 9.7% of the cohort died and 23% became disabled between 1996 and 2002. There were no significant differences in risk of death or disability between veterans (n = 4432) and non-veterans (2205). We then used the VA NPCD to further categorize veterans as: non-users of VHA (n = 3873) and users of VHA (n=559). Older male veterans using VHA services were 1.3 times as likely to become disabled as veterans not using VHA and non-veterans after controlling for demographic factors and health status. There was no difference in the risk of death for veteran users, non-users and non-veterans.
IMPACT:
This project will advance the field by examining incident disability among veterans using a longitudinal nationally-representative data set. Such studies have not been conducted among veterans in the past because no VHA dataset is available with information on functional status of veterans that is both nationally-representative and longitudinal. By merging Medicare and VHA data, the proposed study will also include both VA and non-VA use that might be missed by using either Medicare or VHA data alone. The product of this project will quantify the incidence of new or worsening disability among older veterans and its implications to the VHA in terms of service use.
PUBLICATIONS:
None at this time.
DRA:
Aging and Age-Related Changes, Chronic Diseases, Health Services and Systems
DRE:
Epidemiology, Resource Use and Cost
Keywords:
Disability, Utilization patterns, VA/non-VA comparisons
MeSH Terms:
none
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