Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3036 — Characterizing the Clinical Challenges of Younger VA Nursing Home Patients

Author List:
Lemke SP (Center for Health Care Evaluation, VA Palo Alto Health Care System)
Schaefer JA (Center for Health Care Evaluation & Program Evaluation Resource Center, VA Palo Alto Health Care System)
Fung KZ (Center for Health Care Evaluation, VA Palo Alto Health Care System)

Objectives:
There is some concern that Vietnam Era veterans will present high levels of mental health disorders and behavior problems as they increasingly use VA nursing homes (VANHs). This study aimed to identify differences between younger and older VANH patients and examine patient characteristics related to problem behaviors.

Methods:
Patients admitted to VANHs in the first half of FY00 were identified (n = 13,688) from the National Patient Care Database (NPCD); recent diagnoses and patient characteristics were obtained from NPCD files (FY97 through FY00). The Patient Assessment Form, available for 93% of admitted patients (n = 12,671), provided information on patients’ functioning and behavior problems. Younger (under age 65) and older (age 65+) patients were compared, and predictors of problem behaviors were analyzed using logistic regressions.

Results:
Younger patients had fewer social resources than older patients and were less likely to have functional dependencies or serious medical problems. Older patients had higher prevalence of dementia; younger patients had higher prevalence of a number of other mental health diagnoses. Except for aggressive behavior, which was slightly more common among older patients, problem behaviors were equally likely in younger and older patients. With other factors controlled, presence of problem behaviors was independent of patients’ age. Problem behaviors were more likely among patients with dementia, impaired functioning, or certain psychiatric disorders. Patients with serious medical problems or with depressive disorders were less likely to show problem behaviors.

Implications:
Most of the differences between younger and older VANH patients appear to reflect aging rather than cohort effects. Although younger age does not appear to be a separate risk factor for problem behaviors, younger patients may have a higher prevalence of some psychiatric disorders related to increased risk of problem behaviors.

Impacts:
As the Vietnam Era cohort ages, it may present unique challenges to VANH staff, including higher prevalence of substance use disorder and PTSD. The prevalence of manic disorders and personality disorders also may be higher in this cohort; these diagnoses are risk factors for problem behaviors. Identifying characteristics of this cohort can help staff effectively address these patients’ future care needs.