The Health Status of Elderly Veteran Enrollees in the Veterans Health Administration

Authors

  • Alfredo J. Selim MD, MPH,

    1. From the *Center for Health Quality, Outcomes, and Economic Research, Veterans Affairs (VA) Medical Center, Bedford, MassachusettsSection of General Internal MedicineNormative Aging Study, Boston VA Health Care System, Boston, Massachusetts§Schools of Medicine and Public Health and Department of Mathematics, Boston University, Boston, MassachusettsHealth Institute, New England Medical Center, Boston, Massachusetts#Center for Beneficiary Choices, Centers for Medicare and Medicaid Services, Baltimore, Maryland**Policy Sciences Graduate Program, University of Maryland Baltimore County, Baltimore, Maryland.
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  • Dan R. Berlowitz MD, MPH,

    1. From the *Center for Health Quality, Outcomes, and Economic Research, Veterans Affairs (VA) Medical Center, Bedford, MassachusettsSection of General Internal MedicineNormative Aging Study, Boston VA Health Care System, Boston, Massachusetts§Schools of Medicine and Public Health and Department of Mathematics, Boston University, Boston, MassachusettsHealth Institute, New England Medical Center, Boston, Massachusetts#Center for Beneficiary Choices, Centers for Medicare and Medicaid Services, Baltimore, Maryland**Policy Sciences Graduate Program, University of Maryland Baltimore County, Baltimore, Maryland.
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  • Graeme Fincke MD,

    1. From the *Center for Health Quality, Outcomes, and Economic Research, Veterans Affairs (VA) Medical Center, Bedford, MassachusettsSection of General Internal MedicineNormative Aging Study, Boston VA Health Care System, Boston, Massachusetts§Schools of Medicine and Public Health and Department of Mathematics, Boston University, Boston, MassachusettsHealth Institute, New England Medical Center, Boston, Massachusetts#Center for Beneficiary Choices, Centers for Medicare and Medicaid Services, Baltimore, Maryland**Policy Sciences Graduate Program, University of Maryland Baltimore County, Baltimore, Maryland.
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  • Zhongxiao Cong MS,

    1. From the *Center for Health Quality, Outcomes, and Economic Research, Veterans Affairs (VA) Medical Center, Bedford, MassachusettsSection of General Internal MedicineNormative Aging Study, Boston VA Health Care System, Boston, Massachusetts§Schools of Medicine and Public Health and Department of Mathematics, Boston University, Boston, MassachusettsHealth Institute, New England Medical Center, Boston, Massachusetts#Center for Beneficiary Choices, Centers for Medicare and Medicaid Services, Baltimore, Maryland**Policy Sciences Graduate Program, University of Maryland Baltimore County, Baltimore, Maryland.
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  • William Rogers PhD,

    1. From the *Center for Health Quality, Outcomes, and Economic Research, Veterans Affairs (VA) Medical Center, Bedford, MassachusettsSection of General Internal MedicineNormative Aging Study, Boston VA Health Care System, Boston, Massachusetts§Schools of Medicine and Public Health and Department of Mathematics, Boston University, Boston, MassachusettsHealth Institute, New England Medical Center, Boston, Massachusetts#Center for Beneficiary Choices, Centers for Medicare and Medicaid Services, Baltimore, Maryland**Policy Sciences Graduate Program, University of Maryland Baltimore County, Baltimore, Maryland.
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  • Samuel C. Haffer PhD,

    1. From the *Center for Health Quality, Outcomes, and Economic Research, Veterans Affairs (VA) Medical Center, Bedford, MassachusettsSection of General Internal MedicineNormative Aging Study, Boston VA Health Care System, Boston, Massachusetts§Schools of Medicine and Public Health and Department of Mathematics, Boston University, Boston, MassachusettsHealth Institute, New England Medical Center, Boston, Massachusetts#Center for Beneficiary Choices, Centers for Medicare and Medicaid Services, Baltimore, Maryland**Policy Sciences Graduate Program, University of Maryland Baltimore County, Baltimore, Maryland.
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  • Xinhua S. Ren PhD,

    1. From the *Center for Health Quality, Outcomes, and Economic Research, Veterans Affairs (VA) Medical Center, Bedford, MassachusettsSection of General Internal MedicineNormative Aging Study, Boston VA Health Care System, Boston, Massachusetts§Schools of Medicine and Public Health and Department of Mathematics, Boston University, Boston, MassachusettsHealth Institute, New England Medical Center, Boston, Massachusetts#Center for Beneficiary Choices, Centers for Medicare and Medicaid Services, Baltimore, Maryland**Policy Sciences Graduate Program, University of Maryland Baltimore County, Baltimore, Maryland.
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  • Austin Lee PhD,

    1. From the *Center for Health Quality, Outcomes, and Economic Research, Veterans Affairs (VA) Medical Center, Bedford, MassachusettsSection of General Internal MedicineNormative Aging Study, Boston VA Health Care System, Boston, Massachusetts§Schools of Medicine and Public Health and Department of Mathematics, Boston University, Boston, MassachusettsHealth Institute, New England Medical Center, Boston, Massachusetts#Center for Beneficiary Choices, Centers for Medicare and Medicaid Services, Baltimore, Maryland**Policy Sciences Graduate Program, University of Maryland Baltimore County, Baltimore, Maryland.
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  • Shirley X. Qian MS,

    1. From the *Center for Health Quality, Outcomes, and Economic Research, Veterans Affairs (VA) Medical Center, Bedford, MassachusettsSection of General Internal MedicineNormative Aging Study, Boston VA Health Care System, Boston, Massachusetts§Schools of Medicine and Public Health and Department of Mathematics, Boston University, Boston, MassachusettsHealth Institute, New England Medical Center, Boston, Massachusetts#Center for Beneficiary Choices, Centers for Medicare and Medicaid Services, Baltimore, Maryland**Policy Sciences Graduate Program, University of Maryland Baltimore County, Baltimore, Maryland.
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  • Donald R. Miller ScD,

    1. From the *Center for Health Quality, Outcomes, and Economic Research, Veterans Affairs (VA) Medical Center, Bedford, MassachusettsSection of General Internal MedicineNormative Aging Study, Boston VA Health Care System, Boston, Massachusetts§Schools of Medicine and Public Health and Department of Mathematics, Boston University, Boston, MassachusettsHealth Institute, New England Medical Center, Boston, Massachusetts#Center for Beneficiary Choices, Centers for Medicare and Medicaid Services, Baltimore, Maryland**Policy Sciences Graduate Program, University of Maryland Baltimore County, Baltimore, Maryland.
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  • Avron Spiro III PhD,

    1. From the *Center for Health Quality, Outcomes, and Economic Research, Veterans Affairs (VA) Medical Center, Bedford, MassachusettsSection of General Internal MedicineNormative Aging Study, Boston VA Health Care System, Boston, Massachusetts§Schools of Medicine and Public Health and Department of Mathematics, Boston University, Boston, MassachusettsHealth Institute, New England Medical Center, Boston, Massachusetts#Center for Beneficiary Choices, Centers for Medicare and Medicaid Services, Baltimore, Maryland**Policy Sciences Graduate Program, University of Maryland Baltimore County, Baltimore, Maryland.
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  • Bernardo J. Selim MD,

    1. From the *Center for Health Quality, Outcomes, and Economic Research, Veterans Affairs (VA) Medical Center, Bedford, MassachusettsSection of General Internal MedicineNormative Aging Study, Boston VA Health Care System, Boston, Massachusetts§Schools of Medicine and Public Health and Department of Mathematics, Boston University, Boston, MassachusettsHealth Institute, New England Medical Center, Boston, Massachusetts#Center for Beneficiary Choices, Centers for Medicare and Medicaid Services, Baltimore, Maryland**Policy Sciences Graduate Program, University of Maryland Baltimore County, Baltimore, Maryland.
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  • Lewis E. Kazis ScD

    1. From the *Center for Health Quality, Outcomes, and Economic Research, Veterans Affairs (VA) Medical Center, Bedford, MassachusettsSection of General Internal MedicineNormative Aging Study, Boston VA Health Care System, Boston, Massachusetts§Schools of Medicine and Public Health and Department of Mathematics, Boston University, Boston, MassachusettsHealth Institute, New England Medical Center, Boston, Massachusetts#Center for Beneficiary Choices, Centers for Medicare and Medicaid Services, Baltimore, Maryland**Policy Sciences Graduate Program, University of Maryland Baltimore County, Baltimore, Maryland.
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  • The study was supported by Grant IIR 97–019 from the Health Services Research and Development Service and the Office of Quality and Performance of the Department of Veterans Affairs, Washington, DC, and Center for Beneficiary Choices, Centers for Medicare and Medicaid Services, Baltimore, Maryland.

Address correspondence to Dr. A. Selim, Women's Health Clinic, Boston VA Health Care System, 150 South Huntington Ave., Boston, MA 02130. E-mail: selim.alfredo_j@boston.med.va.gov

Abstract

Objectives: To examine the health status of elderly veteran enrollees, stratified by age group, and compare with nonveteran populations.

Design: Cross-sectional study.

Setting: Outpatient.

Participants: A total of 1,406,049 veteran enrollees were surveyed, and 887,775 returned the questionnaire (63.1%). Of these, 663,729 (74%) were aged 65 and older.

Measurements: Patient demographics, comorbid conditions, and health status, which was assessed using the Veterans 36-item short form (SF-36), a reliable and valid measure of health-related quality of life (HRQoL).

Results: Elderly veteran enrollees are a group with poor health status across all scales of the Veterans SF-36. Significant decline in HRQoL was found in patients grouped by increasing age (65–74, 75–84, and ≥85). Of the Veterans SF-36 scales, the role physical and role emotional scales and physical functioning presented the largest decrements by age group. The elderly veteran enrollees had poorer health status than older people enrolled in Medicare managed care, ranging from 0.5 to 1 standard deviations worse.

Conclusion: Elderly veteran enrollees have substantial disease burden, as reflected by major impairments across multiple dimensions of HRQoL. These findings bear important implications for use of services, suggesting that the Veterans Health Administration will require considerable resources to provide care for its aging population.

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