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Older Veterans (older + veteran)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Greater Prevalence and Incidence of Dementia in Older Veterans with Posttraumatic Stress Disorder

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2010
[See editorial comments by Dr. Soo Borson, pp 1797-1798]
OBJECTIVES: To explore the association between posttraumatic stress disorder (PTSD) and dementia in older veterans. DESIGN: Administrative database study of individuals seen within one regional division of the Veterans Affairs healthcare network. SETTING: Veterans Integrated Service Network 16. PARTICIPANTS: Veterans aged 65 and older who had a diagnosis of PTSD or who were recipients of a Purple Heart (PH) and a comparison group of the same age with no PTSD diagnosis or PH were divided into four groups: those with PTSD and no PH (PTSD+/PH,, n=3,660), those with PH and no PTSD (PTSD,/PH+, n=1,503), those with PTSD and a PH (PTSD+/PH+, n=153), and those without PTSD or a PH (PTSD,/PH,, n=5,165). MEASUREMENTS: Incidence and prevalence of dementia after controlling for confounding factors in multivariate logistic regression. RESULTS: The PTSD+/PH, group had a significantly higher incidence and prevalence of dementia than the groups without PTSD with or without a PH. The prevalence and incidence of a dementia diagnosis remained two times as high in the PTSD+/PH, group as in the PTSD,/PH+ or PTSD,/PH, group after adjusting for the confounding factors. There were no statistically significant differences between the other groups. CONCLUSION: The incidence and prevalence of dementia is greater in veterans with PTSD. It is unclear whether this is due to a common risk factor underlying PTSD and dementia or to PTSD being a risk factor for dementia. Regardless, this study suggests that veterans with PTSD should be screened more closely for dementia. Because PTSD is so common in veterans, this association has important implications for veteran care. [source]

Immunisation Rates in Older Veterans and War Widows

AUSTRALASIAN JOURNAL ON AGEING, Issue 3 2000
Balakrishnan Nair
Aim: To study the immunisation rates of veterans and war widows aged 70 years and above in New South Wales and Queensland, as part of the Preventive Care Trial. Method: A trained health care worker assessed subjects at home regarding health, illness and immunisation status. Results: Suboptimal immunisation rate for influenza (72%) and poor rates for pneumococcus (14%) and tetanus (43%) were detected. Conclusion: Subjects in this study were not immunised according to recommended guidelines. Further education campaigns are warranted to improve immunisation rates in older people. [source]

Greater Prevalence and Incidence of Dementia in Older Veterans with Posttraumatic Stress Disorder

Long-Term Effectiveness of Screening for Hearing Loss: The Screening for Auditory Impairment,Which Hearing Assessment Test (SAI-WHAT) Randomized Trial

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2010
Bevan Yueh MD
OBJECTIVES: To evaluate the effect of hearing screening on long-term hearing outcomes in a general population of older veterans. DESIGN: Hearing loss in the elderly is underdetected and undertreated. Routine hearing screening has been proposed, but it is not clear whether screening identifies patients who are sufficiently motivated to adhere to treatment. A four-arm randomized clinical trial was conducted to compare three screening strategies with no screening in 2,305 older veterans seeking general medical care. SETTING: Veterans Affairs Puget Sound Health Care System. INTERVENTIONS: The screening strategies were a tone-emitting otoscope, a widely used questionnaire about hearing handicap, and a combination of both tools. MEASUREMENTS: Hearing aid use 1 year after screening. RESULTS: Of participants who underwent screening with the tone-emitting otoscope, questionnaire, and combined testing, 18.6%, 59.2%, and 63.6%, respectively, screened positive for hearing loss (P<.01 for test of equality across three arms). Patients proceeded to formal audiology evaluation 14.7%, 23.0%, and 26.6% of the time in the same screening arms, compared with 10.8% in the control arm (P<.01 for test of equality across four arms). Hearing aid use 1 year after screening was 6.3%, 4.1%, and 7.4% in the same arms, compared with 3.3% in the control arm (P<.01). Hearing aid users experienced significant improvements in hearing-related function and communication ability. CONCLUSION: In older veterans, screening for hearing loss led to significantly more hearing aid use. Screening with the tone-emitting otoscope was more efficient. The results are most applicable to older populations with few cost barriers to hearing aids. [source]

High prevalence of orthostatic hypotension and its correlation with potentially causative medications among elderly veterans

JOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 2 2005
I. O. Poon PharmD BCPS CGP
Summary Background:, Orthostatic hypotension (OH) is defined as a reduction of systolic blood pressure of at least 20 mmHg, or diastolic blood pressure of at least 10 mmHg from a sitting to a standing position. It is a common physical finding among older adults and associated with significant morbidity and mortality. Use of medications that have the potential to induce OH, particularly concomitant use of several of such medications, is a major factor for the development of OH. Objectives:, To describe the prevalence of symptomatic and asymptomatic OH in veterans aged 75 years and older attending a geriatric clinic, and to assess the association between OH and the number of potentially causative medications used. Methods:, Charts of all patients who attended a VA geriatric clinic (Michael E. DeBakey VA Medical Center) during the period of 1 June 2002 to 1 June 2003 were reviewed retrospectively for (i) the use of potentially causative medications, i.e. medications that were reported to cause OH in at least 1% of the general population and that were available in the VA formulary, (ii) the presence or absence of OH, and (iii) the presence or absence of symptomatic OH. Patients with primary autonomic dysfunction, Parkinson's disease, and patients who were unable to stand, or who had no assessment for both sitting and standing blood pressure for other reasons were excluded. Results:, A total of 505 individual patients attended the clinic during the study period, and 342 patients fit the inclusion criteria. About 189 of these patients (55%) had OH. Among patients with OH, 61 patients (33%) were symptomatic, including 52 patients who had falls. The prevalence of OH in patients receiving zero, one, two, and three or more potentially causative medications was 35, 58, 60 and 65% respectively. Receiving hydrochlorothiazide was associated with the highest prevalence of OH (65%), followed by receiving lisinopril (60%), trazodone (58%), furosemide (56%) and terazosin (54%). Conclusion:, The prevalence of OH is very high in older veterans and significantly related to the number of concurrent causative medications used. Providers should be educated to reduce the amount of potentially causative medications in the elderly and better assess patients in which use of such medications is necessary to avoid symptomatic OH. [source]

Do Older Rural and Urban Veterans Experience Different Rates of Unplanned Readmission to VA and Non-VA Hospitals?

THE JOURNAL OF RURAL HEALTH, Issue 1 2009
William B. Weeks MD
ABSTRACT:,Context: Unplanned readmission within 30 days of discharge is an indicator of hospital quality. Purpose: We wanted to determine whether older rural veterans who were enrolled in the VA had different rates of unplanned readmission to VA or non-VA hospitals than their urban counterparts. Methods: We used the combined VA/Medicare dataset to examine 3,513,912 hospital admissions for older veterans that occurred in VA or non-VA hospitals between 1997 and 2004. We calculated 30-day readmission rates and odds ratios for rural and urban veterans, and we performed a logistic regression analysis to determine whether living in a rural setting or initially using the VA for hospitalization were independent risk factors for unplanned 30-day readmission, after adjusting for age, sex, length of stay of the index admission, and morbidity. Findings: Overall, rural veterans had slightly higher 30-day readmission rates than their urban counterparts (17.96% vs 17.86%; OR 1.006, 95% CI: 1.0004, 1.013). For both rural- and urban-dwelling veterans, readmission after using a VA hospital was more common than after using a non-VA hospital (20.7% vs 16.8% for rural veterans, 21.2% vs 16.1% for urban veterans). After adjusting for other variables, readmission was more likely for rural veterans and following admission to a VA hospital. Conclusions: Our findings suggest that VA should consider using the unplanned readmission rate as a performance metric, using the non-VA experience of veterans as a performance benchmark, and helping rural veterans select higher performing non-VA hospitals. [source]

Treatment choices in life threatening illness: Attitudes and preferences of elderly Australian Veterans and War Widows

AUSTRALASIAN JOURNAL ON AGEING, Issue 4 2002
Felicity Barr
Objectives: The study investigated whether older Australians would choose invasive or active treatment or palliative treatment were they to have a life threatening illness. Reasons for choice of treatment were also investigated. Methods: 109 older veterans and war widows were offered four case studies of patients with a life threatening illness. For each patient there were four treatment options with likely outcomes described. Participants were asked to put themselves in the position of the patient and to select one or more treatment option and to give reasons for their choice. Results: There was considerable diversity in choice of treatment and reasons for choice. Overall, participants were more likely to choose palliative than invasive treatments. Men, especially older men, were more likely than women to choose invasive treatments. Discussion: The study indicated that participants want to exercise choice in their treatment but that they want this to be an informed choice. [source]