Pharmacotherapy for Older Veterans Diagnosed With Posttraumatic Stress Disorder in Veterans Administration

Abstract

Despite increasing numbers of older veterans diagnosed with posttraumatic stress disorder (PTSD) in veterans administration (VA), limited research has focused on pharmacotherapy of PTSD among the elderly. The authors examined pharmacotherapy provided to patients carrying a clinical diagnosis of PTSD in VA. Data on outpatients treated at VA nationally were utilized. Patients were veterans over 45 years of age diagnosed with PTSD in FY 2004 (N = 244,947) grouped into five age cohorts with patients 45-55 as the reference group. Psychotropic prescriptions were examined. Descriptive statistics and multivariable logistic regression adjusting for confounding characteristics, including receipt of VA service connected disability benefits which may create incentives to artificially maintain historical diagnoses, were used to identify the relationship of age to receipt of psychotropic medications net of these factors. All analyses were repeated using data only from nonservice connected veterans. Most older veterans received psychotropic medication and among these, 88.3% were prescribed antidepressants, 61.2% anxiolytics/sedative hypnotics, and 32.9% antipsychotics. A pronounced monotonic trend showed decrease use of any psychotropic medication and of each subclass with age. Medication use was higher among those treated in specialty mental health clinics than among those treated exclusively in primary care or medical clinics and interaction analysis of age by clinic type showed significantly more steeply declining use of medications with age among patients treated in specialty mental health clinics. Data from nonservice connected veterans revealed the same patterns. Diverse psychotropic medication classes are used to treat veterans diagnosed with PTSD in VA with declining use among older veterans. Medication utilization is greater in mental health clinics but declined more steeply with age, perhaps reflecting the greater sensitivity of specialists to the risks of elderly veterans. Older veterans diagnosed with PTSD appear to receive conservative, cautious treatment although observed patterns of care may reflect some degree of undertreatment.