MENTAL HEALTH DIAGNOSES IN VETERANS REFERRED FOR OUTPATIENT GERIATRIC PSYCHIATRIC CARE AT A VETERANS AFFAIRS MEDICAL CENTER

Abstract

Introduction In 2015, 47% of the U.S. Veteran population consisted of individuals 65 years of age and older. This percentage is projected to remain stable for at least the next 15 years. Relative to non-veterans of similar age, older Veterans are at higher risk for mental health disorders. The negative impacts of these conditions are substantial. Later-life depression and neurocognitive disorders are associated with impaired function, increased mortality, diminished health and functioning of caregivers, and significant health care costs to society. There is a relative shortage of geriatric specialty-trained providers, and a lack of necessary knowledge and skills to meet the mental health needs of the aging population, particularly among Veterans. With recognition that the supply of geriatric specialty-trained providers is unable to keep pace with the number of Veterans seeking their services, we are conducting a Quality Improvement initiative to advance the efficiency and delivery of mental health interventions for older Veterans served at the Minneapolis Veterans Affairs Health Care System (MVAHCS). This presentation reports the initial efforts to understand the demographic and diagnostic characteristics of Veterans seen for outpatient geriatric subspecialty mental health care at MVAHCS. Methods Retrospective chart review of demographics and psychiatric diagnoses in Veterans seen for outpatient geriatric mental health intake between May 1, 2011 and April 30, 2016, at the MVAHCS. Descriptive statistics were performed using Microsoft Excel. Chi-square analysis of diagnosis by military service era were conducted using SPSS version 19. Results A total of 1059 Veterans were evaluated. Descriptive statistics on age, sex, race, marital status, military service era and mental disorder prevalence are reported in the Table. 1732 mental health diagnoses were coded among the Veteran sample. The top ten mental health diagnostic categories, in descending order of prevalence, included: depression, neurocognitive, anxiety, posttraumatic stress, alcohol use, adjustment, sleep, mood/bipolar, personality, psychosis. Prevalence of depressive, neurocognitive, anxiety, posttraumatic stress, and alcohol use disorders showed a statistically significant association with service era. Depressive disorders were most prevalent in Vietnam Veterans (56%), whereas neurocognitive disorders were most prevalent in World War II Veterans (71%) (see Figure). Conclusions The prevalence of major mental health conditions is high in Veterans seen in geriatric psychiatry. When examining diagnoses within service era subgroups, these subgroups differ in the prevalence of several major diagnostic categories. Vietnam Veterans show a relatively higher prevalence of depressive, posttraumatic stress, and alcohol use diagnoses. This finding is consistent with other studies supporting elevated rates of psychiatric problems in Vietnam Veterans relative to other service eras, potentially due to differing military experiences and relatively less homecoming support. As the relatively younger group, they represent the cohort that geriatric specialists will see in larger proportion over the coming years. Also, as age is the primary risk factor in later-life neurodegenerative diseases, we anticipate greater incidence of neurocognitive disorders among Vietnam Veterans in the future. In the present study, post-hoc analysis of the association of age with neurocognitive disorder prevalence showed a significant positive correlation (Spearman's rho = 0.38, p This research was funded by None.