Protective and Risk Factors for 5-Year Survival in the Oldest Veterans: Data from the Veterans Health Administration

TitleProtective and Risk Factors for 5-Year Survival in the Oldest Veterans: Data from the Veterans Health Administration
Publication TypeJournal Article
Year of Publication2016
AuthorsCho, J, Copeland, LA, Stock, EM, Zeber, JE, Restrepo, MI, MacCarthy, AA, Ory, MG, Smith, PA, Stevens, AB
JournalJournal of the American Geriatrics Society
Volume64
Issue6
Pagination1250 - 1257
Date PublishedJan-06-2016
KeywordsHealth Conditions and Status, Longevity, Mortality, Older Adults, Risk Factors, Trauma, Veterans
Abstract

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.

URLhttp://doi.wiley.com/10.1111/jgs.14161http://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Fjgs.14161
DOI10.1111/jgs.14161
Short TitleJ Am Geriatr Soc
Citation Key8757
PubMed ID27321603
PubMed Central IDPMC4916847