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Serious mental illness, aging, and utilization patterns among veterans.

John E Zeber1, Laurel A Copeland, Kyle L Grazier

  • 1Veterans Evidence-Based Research Dissemination Implementation Research Center (VERDICT), Department of Veterans Affairs, South Texas Veterans Health Care System (HSR&D), San Antonio, TX 78229, USA.

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The Veterans Health Administration saw decreased inpatient stays and increased outpatient visits after deinstitutionalization. Aging veterans, particularly those with mental health conditions, are increasing demand on healthcare services.

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Area of Science:

  • Health Services Research
  • Gerontology
  • Psychiatric Epidemiology

Background:

  • Chronic physical and psychiatric conditions pose challenges to the Veterans Health Administration (VHA) as the veteran population ages.
  • The VHA implemented a deinstitutionalization policy in 1995, shifting care from inpatient to outpatient settings.
  • Understanding healthcare utilization patterns is crucial for managing the evolving needs of aging veterans.

Purpose of the Study:

  • To examine the influence of age and diagnosis on healthcare utilization among veterans.
  • To assess the impact of the VHA's 1995 deinstitutionalization policy on service use.
  • To identify trends in inpatient and outpatient service utilization over a five-year period.

Main Methods:

  • Analysis of healthcare utilization data for 7,719 veterans over five years.
  • Inclusion of diagnoses such as schizophrenia, bipolar disorder, depression, and alcohol dependence.
  • Statistical modeling to adjust for demographic and diagnostic factors influencing utilization.

Main Results:

  • A 14% decrease in inpatient days and a 63% increase in outpatient (OP) visits were observed, aligning with deinstitutionalization.
  • OP utilization significantly increased with age, while psychiatric visits, especially for alcohol dependence, decreased.
  • Emergency visits rose post-1997, disproportionately affecting ethnic minorities.

Conclusions:

  • Healthcare utilization patterns among veterans change across the life course, necessitating proactive planning for demographic shifts.
  • Aging veterans, particularly the 35-64 age groups, represent a growing demand for OP care, straining existing resources.
  • Monitoring mental health utilization is vital for policymakers and providers to address the psychiatric needs of an aging veteran population.