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Penrod JD (James J. Peters VA), Zhu CW
(James J. Peters VA), Dellenbaugh C
(James J. Peters VA), Hebert P
(Mount Sinai School of Medicine), Keyhani S
(Mount Sinai School of Medicine), Doucette J
(Mount Sinai School of Medicine), Federman A
(Mount Sinai School of Medicine), Siu AL
(James J. Peters VA)
Objectives:
To compare predictors of incident disability in older non-veterans, veterans not using VHA, and veteran VHA users.
Methods:
We merged data from the 1996-2003 Medicare Current Beneficiary Survey (MCBS) with the VA National Patient Care Database (NPCD) to identify 6,637 male MCBS participants age 65 and older with no disability (no difficulty with any of six activities of daily living [ADLs]) on entry to MCBS. MCBS participants are followed for three years. We defined incident (new onset) disability as difficulty in any ADL at any time after the first follow-up interview in the MCBS. We estimated discrete time hazard models with follow up from 1 to 3 years, adjusting for baseline age, race/ethnicity, marital status, income, education, secondary insurance, self-reported health, hospitalization in prior 12 months, smoking, use of psychiatric medications, comorbidities and veteran status. Participants who died during their three-year follow-up were excluded.
Results:
Participants included 2,205 non-veterans, 3,873 veteran non-users (veterans not using VHA at MCBS enrollment) and 559 veteran users (veterans using VHA at MCBS enrollment). About 25% of non-veterans, 21% of veteran non-users and 28% of veteran users experienced new onset disability. The odds of incident disability were significantly higher for those who were older, Medicaid recipients, reported worse health, hospitalized in the past year, smokers, using psychotropic medications and had more comorbid illness. Compared to non-veterans, the odds of incident disability were 26% higher (p=. 03) for veteran users of VHA. Non-veterans and veteran non-users did not differ in their risk of incident disability.
Implications:
Older Medicare beneficiaries who are veterans using VHA for care are more likely to experience new disability after controlling for demographic and health differences compared to non-veterans
Impacts:
Older veteran users of VHA care are at risk for late life incident disabilities. More research is warranted to identify these vulnerable veterans and opportunities to enhance their functional status.
