TY - JOUR
T1 - Protective and Risk Factors for 5-Year Survival in the Oldest Veterans
T2 - Data from the Veterans Health Administration
AU - Cho, Jinmyoung
AU - Copeland, Laurel A.
AU - Stock, Eileen M.
AU - Zeber, John E.
AU - Restrepo, Marcos I.
AU - MacCarthy, Andrea A.
AU - Ory, Marcia G.
AU - Smith, Paul A.
AU - Stevens, Alan B.
N1 - Funding Information:
Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Laurel Copeland: unpaid Governing Board member representing Baylor Scott & White in the Health Care Systems Research Network (formerly HMO Research Network); grant funding from the VHA including HX-09–335, National Institute of Mental Health, Scott & White Research, VA Office of Rural Health, the Henry M. Jackson Foundation for the Advancement of Military Medicine (with Wounded Warrior Project, Walmart Foundation, May & Stanley Smith Charitable Trust, Robert R. McCormick Foundation, Onward Veterans and Schultz Family Foundation, Bob Woodruff Foundation, Phil & Marge Odeen, and the Rumsfeld Foundation). John Zeber: Health Services Research and Development Service merit grant on infectious disease (PI), Mental Health Research Network (coinvestigator), Astra-Zeneca drug safety study (PI, pending); board (unpaid): Academy health behavioral interest group advisory board, World Journal of Psychiatry editorial board. Marcos Restrepo's time is partially protected by Award K23HL096054 from the National Heart, Lung, and Blood Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute; National Institutes of Health; or Department of Veterans Affairs. Author Contributions: Cho, Copeland: conceptual development, acquisition of subjects and data, analysis and interpretation of data, preparation of manuscript, critical review of manuscript. Stock, MacCarthy: acquisition of subjects and data, analysis of data. Zeber, Restrepo, Ory, Stevens: study design, manuscript preparation, critical review of manuscript. Smith: critical review of manuscript as a geriatrician. Sponsor's Role: The funding agencies had no role in the preparation, review, or approval of the manuscript.
Publisher Copyright:
© 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Objectives: To characterize physical and mental diseases and use of healthcare services and identify factors associated with mortality in the oldest individuals using the Veterans Health Administration (VHA). Design: Retrospective study with 5-year survival follow-up. Setting: VHA, system-wide. Participants: Veterans using the VHA aged 80 and older as of October 2008 (N = 721,588: n = 665,249 aged 80–89, n = 56,118 aged 90–99, n = 221 aged 100–115). Measurements: Demographic characteristics, physical and mental diseases, healthcare services, and 5-year survival were measured. Results: Accelerated failure time models identified protective and risk factors associated with mortality according to age group. During 5 years of follow-up, 44% of participants died (survival rate: 59% aged 80–89, 32% aged 90–99, 15% aged ≥100). In the multivariable model, protective effects for veterans aged 80–99 were female sex, minority race or ethnicity, being married, having certain physical and mental diagnoses (hypertension, cataract, dyslipidemia, posttraumatic stress disorder, bipolar disorder), having urgent care visits, having invasive surgery, and having few (1–3) prescriptions. Risk factors were lower VHA priority status, physical and mental conditions (diabetes mellitus, anemia, congestive heart failure, dementia, anxiety, depression, smoking, substance abuse disorder), hospital admission, and nursing home care. For those aged 100 and older, being married, smoking, hospital admission, nursing home care, invasive surgery, and prescription use were significant risk factors; only emergency department (ED) use was protective. Conclusion: Although the data are limited to VHA care (thus missing Medicare services), this study shows that many veterans served by the VHA live to advanced old age despite multiple chronic conditions. Further study is needed to determine whether a comprehensive, coordinated care system like VHA is associated with greater longevity for very old persons.
AB - Objectives: To characterize physical and mental diseases and use of healthcare services and identify factors associated with mortality in the oldest individuals using the Veterans Health Administration (VHA). Design: Retrospective study with 5-year survival follow-up. Setting: VHA, system-wide. Participants: Veterans using the VHA aged 80 and older as of October 2008 (N = 721,588: n = 665,249 aged 80–89, n = 56,118 aged 90–99, n = 221 aged 100–115). Measurements: Demographic characteristics, physical and mental diseases, healthcare services, and 5-year survival were measured. Results: Accelerated failure time models identified protective and risk factors associated with mortality according to age group. During 5 years of follow-up, 44% of participants died (survival rate: 59% aged 80–89, 32% aged 90–99, 15% aged ≥100). In the multivariable model, protective effects for veterans aged 80–99 were female sex, minority race or ethnicity, being married, having certain physical and mental diagnoses (hypertension, cataract, dyslipidemia, posttraumatic stress disorder, bipolar disorder), having urgent care visits, having invasive surgery, and having few (1–3) prescriptions. Risk factors were lower VHA priority status, physical and mental conditions (diabetes mellitus, anemia, congestive heart failure, dementia, anxiety, depression, smoking, substance abuse disorder), hospital admission, and nursing home care. For those aged 100 and older, being married, smoking, hospital admission, nursing home care, invasive surgery, and prescription use were significant risk factors; only emergency department (ED) use was protective. Conclusion: Although the data are limited to VHA care (thus missing Medicare services), this study shows that many veterans served by the VHA live to advanced old age despite multiple chronic conditions. Further study is needed to determine whether a comprehensive, coordinated care system like VHA is associated with greater longevity for very old persons.
KW - health services
KW - oldest
KW - survival
KW - veterans
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U2 - 10.1111/jgs.14161
DO - 10.1111/jgs.14161
M3 - Article
C2 - 27321603
AN - SCOPUS:84975317644
SN - 0002-8614
VL - 64
SP - 1250
EP - 1257
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 6
ER -