ADVERSE OUTCOMES, POLYSUBSTANCE USE, AND POLYPHARMACY IN OLDER VETERANS

Abstract

Older veterans have the highest number of lives lost to suicide, make up majority of the veteran population, and are highly likely to experience conditions (e.g., chronic pain, sleep disorders, musculoskeletal) associated with commonly prescribed medications that are potential markers for suicide risk (hereafter referred to as “high-risk” drug categories), including benzodiazepines, sedative-hypnotics, opioids, antidepressants, antipsychotics, and antiepileptics. The research presented in this session will highlight important patterns in high-risk drug prescribing and use and related outcomes in late life. The presentations will highlight various groups of older veterans that may be important to consider and, yet, neglected in the polysubstance and polypharmacy and suicide prevention conversation, including those who recently attempted suicide, veterans with late-life posttraumatic stress disorder (PTSD), and older veterans transitioning from prison to community. Drs. Maust and Morin will present findings on polypharmacy prescribing and use of high-risk medications in late life. First, drawing from the literature and his own research studies, Dr. Maust will provide a big picture overview of trends in polypharmacy among older adults in the U.S., including older veterans. Next, Dr. Morin will describe high-risk profiles of use in the 90 days prior to a first documented suicide attempt among veterans >=65 years who attempted suicide between 2012 and 2014, using Veterans Health Administration (VHA) medical record data. In addition, she will examine associations of these profiles with diagnostic, lethality, and utilization factors. Drs. Byers and Barry will speak about more specific subgroups of older veterans, with recommendations for possible intervention to reduce suicide, unintended death by overdose, and substance use disorder (SUD)-related emergency department (ED) visits and hospitalizations, emphasizing importance of care transition models for prevention. Dr. Byers will present a cohort study of veterans >=50 years seen in VHA. Findings provide evidence that late-life PTSD increases risk of suicide attempts and suicide by overdose (and accidental and undetermined death), independent of comorbid disorders. Furthermore, findings will be presented about the relationship of late-life PTSD to cause-specific high-risk drugs. Finally, Dr. Barry will provide an example of increased risk for SUD-related ED visits and hospitalizations (found in the literature to be strongly associated with suicide attempts) among older veterans transitioning from prison to community. Findings show that those re-entering society following prison sentence are at significantly higher risk for SUD-related ED visit or hospitalization compared to matched controls. These results highlight urgent need for assistance during this vulnerable period of transition.