1035 — The Changing Mental Health Profile of VA Nursing Home Patients

Lemke SP (Center for Health Care Evaluation), Schaefer JA (Center for Health Care Evaluation)

Objectives:
Myriad factors influence mental health disorder prevalence among VA nursing home (VANH) patients. Projection of future trends can be improved by a better understanding of these factors. To this end, we examined evidence for age, cohort, and period effects in recent changes in mental health disorder prevalence in VANHs.

Methods:
VANH admissions in FY98 (n = 27,734) and FY06 (n = 32,543) were identified in the National Patient Care Database. Patients’ recent mental health diagnoses were obtained from inpatient and outpatient records for the 3-year period including VANH admission. The prevalence of mental health disorders for different age groups and birth cohorts in 1998 and 2006 were compared.

Results:
Overall, increasing numbers of patients admitted to VANHs carry a mental health diagnosis (63% in 1998, 67% in 2006). Drug use disorders and PTSD showed the expected increases in prevalence, coinciding with the influx of the Vietnam Era and later cohorts with a high prevalence of these disorders. Drug use disorders increased from 6% to 9%, and PTSD increased from 5% to 12%. Alcohol use disorder prevalence declined slightly (from 18% to 16%) and did so for all birth cohorts. Depression prevalence increased markedly (from 27% to 37%). This increase occurred across age and birth cohorts and likely reflects mainly improved screening and diagnosis. Prevalence of serious mental illness (SMI) increased from 19% to 22%, largely limited to the oldest age groups. Dementia prevalence declined slightly (from 35% to 32%), possibly a result of the diluting effect of increased numbers of short-stay VANH patients and use of alternative placements for dementia patients.

Implications:
Consistent with expectations, the cohort of aging Vietnam Era veterans is driving increases in the prevalence of drug use disorders, PTSD, and possibly depression among VANH admissions. Policy changes, improved screening, and availability of alternative placements appear to account for shifts in the prevalence of other mental health disorders among VANH patients.

Impacts:
VANH managers and policymakers face the challenge of developing resources and effective models of care to address the likely increased demands that patients with drug use disorders, PTSD, and depression will place on the long-term care system.