National Meeting 2007

3006 — Self-Reported Health Care Utilization Rates of Older and Younger Veterans with Depressive Symptomology

Bolkan C (VA Puget Sound Healthcare System; University of Washington) , Chaney E (VA Puget Sound Healthcare System; University of Washington), Rubenstein L (VA Greater Los Angeles HSR&D Center of Excellence, Sepulveda, CA; University of California, Los Angeles), Lanto A (VA Greater Los Angeles HSR&D Center of Excellence, Sepulveda, CA), Yano E (VA Greater Los Angeles HSR&D Center of Excellence, Sepulveda, CA; University of California, Los Angeles)

Objectives:
Depression is a leading cause of disability and also substantially affects medical costs and quality of life. Improvements in depression care may have the greatest impact on older patients, however, representative samples of depressed primary care patients are rarely evaluated by age. We explored differences in self-reported health care utilization rates by young (< 59, n = 433) and older (60 +, n = 328) veterans in the 6 months prior to receiving collaborative care treatment for depression. Patient perception of involvement in care has important implications for patient-oriented, recovery based treatment.

Methods:
This study included a representative sample of 761 patients from 10 VA primary care clinics in 3 VA networks across diverse regional areas. All participants screened positive for depression using the PHQ9 and were enrolled in an evidence-based care model study (TIDES) to investigate the effectiveness of collaborative care for the treatment of depression. Participants answered questions on health status, health care utilization, and demographics.

Results:
We found no significant difference in perceived health status between the two groups. Patients were equally likely to report key physiological depressive symptoms, however older patients were less likely to report cognitive or emotional symptoms. Several disparities in perceived health care utilization emerged. Older patients were more likely admitted to a hospital for multiple nights (X2 = 13.02, p = .00), but less likely visited mental health specialists (X2 = 81.55, p = .00). Older patients reported fewer ER visits for emotional problems at the VA (F = 4.23, p = .04), and fewer outpatient visits for emotional problems at the VA, (F = 17.6, p = .00), or outside of the VA (F = 9.29, p = .00).

Implications:
Before enrollment in TIDES, older patients perceived less mental health involvement than younger patients, despite similarity in perceived health status and overall depression scores. Older patients were also less likely to report cognitive and emotional depressive symptoms.

Impacts:
Addressing older veterans’ self-perception of the need for mental health care may be crucial in promoting recovery from late life depression. Additionally, recognition of older veterans’ unique barriers (i.e., stigma, ageism) to participating in depression treatment is necessary.