2004. Serious Mental Illness and Aging within the Veteran Population
JE Zeber, SMITREC, Ann Arbor, and University of Michigan, LA Copeland, Ann Arbor, K Grazier, University of Michigan

Objectives: The veteran population is aging rapidly, with the percentage over age 65 expected to rise from 43% to 51% by 2010, and individuals over age 80 increasing eight-fold. Chronic health conditions accumulate and add to illness burden as age increases. A consistent rise in medical care use with age is well documented; however, similar research on psychiatric disorders is fairly limited. Recent efforts to mandate parity between medical and mental health care could result in tremendous increases in demand for services, if age-related needs for mental disorders parallel those of the medically ill. This project seeks to examine the interaction between age and psychiatric diagnosis on service utilization patterns over the lifespan. In addition, the study was designed to consider the 1995 VA re-organization and in gauging the effect of de-institutionalization upon an especially vulnerable patient group.

Methods: Eligible veterans (N=7719) had inpatient diagnosis and treatment of schizophrenia, bipolar disorder, major depression, or alcohol dependence, during fiscal years 1995, 1997, and 1999. Age was categorized in 10 years blocks, from 20-80+, and utilization changes over time analyzed via repeated measures models across multiple treatment domains.

Results: Overall admissions and hospital days declined consistently after age 40, although surgeries and procedures increased.  While medical outpatient stops greatly increased with age as expected, mental health stops especially alcohol treatment dropped sharply.  SMI patients (schizophrenia and bipolar) required more inpatient services compared with alcoholism or depression, especially among the young. The mean service-connection percentage, an eligibility marker for some services, was markedly higher for schizophrenia (52%) compared to major depression (25%). Finally, regardless of diagnosis or age, emergency room services rose dramatically between 1995 and 1999.

Conclusions: In general, age effects dominated diagnosis in predicting utilization. Oldest veterans tended to use fewer services overall. Inpatient utilization reacted slower to de-institutionalization, initially rising in 1997 before falling; conversely, outpatient visits increased markedly throughout the study period.

Impact: These findings contribute to an effective planning and policy tool in providing for diverse needs of aging veterans. Long-term care provisions in the 1999 Millennium Bill could offer dramatic ramifications regarding age, diagnosis and illness severity for this vulnerable population.