Protective and Risk Factors for 5-Year Survival in the Oldest Veterans: Data from the Veterans Health Administration.
To characterize physical and mental diseases and use of healthcare services and identify factors associated with mortality in the oldest individuals using the Veterans Health Administration (VHA).



Retrospective study with 5-year survival follow-up.



VHA, system-wide.



Veterans using the VHA aged 80 and older as of October 2008 (N = 721,588: n = 665,249 aged 80-89, n = 56,118 aged 90-99, n = 221 aged 100-115).



Demographic characteristics, physical and mental diseases, healthcare services, and 5-year survival were measured.



Accelerated failure time models identified protective and risk factors associated with mortality according to age group. During 5 years of follow-up, 44% of participants died (survival rate: 59% aged 80-89, 32% aged 90-99, 15% aged ≥100). In the multivariable model, protective effects for veterans aged 80-99 were female sex, minority race or ethnicity, being married, having certain physical and mental diagnoses (hypertension, cataract, dyslipidemia, posttraumatic stress disorder, bipolar disorder), having urgent care visits, having invasive surgery, and having few (1-3) prescriptions. Risk factors were lower VHA priority status, physical and mental conditions (diabetes mellitus, anemia, congestive heart failure, dementia, anxiety, depression, smoking, substance abuse disorder), hospital admission, and nursing home care. For those aged 100 and older, being married, smoking, hospital admission, nursing home care, invasive surgery, and prescription use were significant risk factors; only emergency department (ED) use was protective.



Although the data are limited to VHA care (thus missing Medicare services), this study shows that many veterans served by the VHA live to advanced old age despite multiple chronic conditions. Further study is needed to determine whether a comprehensive, coordinated care system like VHA is associated with greater longevity for very old persons.
Baylor Scott & White Health, Temple, Texas.|Texas A&M Health Science Center, College Station, Texas.
Jinmyoung
J
Cho
Baylor Scott & White Health, Temple, Texas.|Texas A&M Health Science Center, College Station, Texas.|Central Texas Veterans Health Care System, Temple, Texas.
Laurel A
LA
Copeland
Baylor Scott & White Health, Temple, Texas.|Texas A&M Health Science Center, College Station, Texas.|Central Texas Veterans Health Care System, Temple, Texas.
Eileen M
EM
Stock
Baylor Scott & White Health, Temple, Texas.|Texas A&M Health Science Center, College Station, Texas.|Central Texas Veterans Health Care System, Temple, Texas.
John E
JE
Zeber
University of Texas Health Science Center San Antonio, San Antonio, Texas.|South Texas Veterans Health Care System, San Antonio, Texas.
Marcos I
MI
Restrepo
South Texas Veterans Health Care System, San Antonio, Texas.
Andrea A
AA
MacCarthy
Texas A&M Health Science Center, College Station, Texas.
Marcia G
MG
Ory
Baylor Scott & White Health, Temple, Texas.
Paul A
PA
Smith
Baylor Scott & White Health, Temple, Texas.|Texas A&M Health Science Center, College Station, Texas.
Alan B
AB
Stevens
D000369:Aged, 80 and over; D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*
health services; oldest; survival; veterans