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Cognitive and Functional Impairment Among Enrolled and Non Enrolled Veterans 4.24.08

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Leonard Davis Institute of Health Economics
Leonard Davis Institute of Health Economics

Author: Bruce Kinosian

Health & Medicine
1 of 1
Cognitive and Functional Impairment Among Enrolled and Non-Enrolled Veterans: The 2004 National Long Term Care Survey Bruce Kinosian(1,2); E. Stallard (3); K. Manton (3) (1) CHERP, Philadelphia VA Medical Center, Philadelphia, PA, (2) Division of General Internal Medicine, University of Pennsylvania, PA (3) Duke University, Durham, NC ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Work funded by VA HSR&D and ADUSH Office of Policy and Planning ,[object Object],[object Object],Survey Sample New 2004/Old 2004 Enrolled (%) 63/65 16/13 7.2/7.9 7.9/6.3 6.1/7.6 A fundamental finding over the last 20 years in the demography of aging is the declining rate of disability. Whether disability is declining in the enrolled veteran population may vary not only because of demographic trends but because of enrollment decisions of the most frail veterans. By as recently as 2004, VA had no comprehensive functional ascertainment of all veterans, regardless of location or enrollment status. Background ,[object Object],[object Object],Objectives Purpose: To determine the differences between enrolled veterans and non-enrolled veterans aged >65 in terms of cognitive and functional impairments, and long term care use. Methods: Modification of the 6th round of the National Long Term Care Survey (NLTCS) to screen the entire sample of 20,474 respondents as to their veteran status. The sample was matched with the Veterans Health Administration (VHA) files to determine enrollment status. The NLTCS is a panel survey with replacement of both the community and institutional elderly population with Medicare (94% of veterans age 65+). Cognitive impairment was measured using the Short Portable Mental Status Questionnaire and report of dementia/Alzheimer's disease. Results: Of 8041 males, 1,575 of 4,294 self-reported veterans were enrolled in VHA (37%). 162,429 veterans resided in nursing homes (1.7%), of whom 102,129 were enrolled veterans (3.2%). Of the 500,229 veterans who were cognitively impaired (5.2%), 293,632 were enrolled (9%). Cognitive impairment enrolled:all veteran ratios varied by region, with the highest in the south (11.2%/5.6%), least in northeast (6.8%/5.2%). Among all community dwelling veterans, 5.7% (540,696) had at least one ADL impairment requiring at least stand-by human assistance; while 9% (283,882) of community dwelling enrolled veterans had 1 or more ADL impairments. Compared to the 1999 sample there was no change in the prevalence of NH use among enrolled veterans. Compared to VHA projections of dementia for 2004, total prevalence was 5% less (500,000 v.527,000 projected) but enrolled prevalence was 34%greater(293,000 v. 218,000 projected). Conclusion: VA enrolls a disproportionate share of cognitively and functionally impaired veterans, with greater use of nursing home care. Understanding the reasons for this differential enrollment is important in fashioning benefits and projecting future care demands. Abstract ,[object Object],[object Object],[object Object],[object Object],[object Object],Methods ,[object Object],[object Object],[object Object],[object Object],Results ,[object Object],[object Object],[object Object],[object Object],Conclusions ,[object Object],[object Object],Policy Implications

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