Health Characteristics and Treatment Patterns of VHA Veterans Diagnosed With PTSD in Later Life

Abstract Older adults may exhibit symptoms of Post-Traumatic Stress Disorder (PTSD) after a traumatic event, even if they do not meet the criteria for a full diagnosis. This sub-clinical PTSD affects 7-15% of older adults and is associated with elevated depressive symptoms, suicidal ideation, and poorer physical health. Individuals with sub-clinical PTSD often experience worsening symptoms, resulting in a full diagnosis of PTSD, albeit late onset. This evaluation informs the Veterans Health Administration (VHA)’s understanding of the developmental course of PTSD in older Veterans. VHA administrative data were used to examine health characteristics and service utilization in the five years before and five years after the initial VHA documentation of PTSD. We identified a cohort of Veterans (n=27,610), alive and with at least 1 encounter in all evaluation years, with a first PTSD diagnosis documented between ages 50-59, a cohort outside of the average age of diagnosis, but before Medicare eligibility. We compared periods before and after diagnosis across different ages of first diagnosis (50-54, 55-59). Veterans diagnosed at later ages (55-59) had a greater number of mental and physical health conditions. Increasing VHA use preceded a PTSD diagnosis in both groups, but the increase was steeper among those diagnosed at 55-59. Future analyses will compare these patterns to those of Veterans diagnosed at younger ages. Findings from this work may provide a profile of persons at risk for late-life PTSD for use in targeting interventions earlier to reduce the risk of developing worsening PTSD symptoms in late life.

group, the JoyAge preventive care is more effective among those who reported behavioral symptoms (b=0.44,p<0.05,OR=1.55, 95% CI: 1.01, 2.40), but less so in those who had cognitive appraisal issues (b=-0.42,p<0.05,OR=0.66, 95% CI: 0.46, 0.96).For the intervention group, the JoyAge intervention was more effective in treatment among those who reported more affective symptoms (b=0.46,p<0.05,OR=1.59, 95% CI: 1.05, 2.42).The benefits of JC JoyAge steppedcare are differentially associated with participants' baseline profile.Participants' overall depressive symptom severity and the presentation of symptom clusters need to be taken into consideration when delivering the services.

EMENTAL HEALTH LITERACY AND THE RELATIONSHIP TO BARRIERS TO MENTAL HEALTH CARE
Eve Root, and Grace Caskie, Lehigh University, Bethlehem, Pennsylvania, United States According to the American Psychological Association (2017), one in four individuals who are 65 years and older experience a mental health problem; however, many older adults do not receive the services they need and deserve (Karlin, 2008).The current study utilizes a new concept similar to eHealth Literacy called eMental Health Literacy, defined as the degree to which individuals obtain, process, and understand basic mental health information and services needed to aid their recognition, management, or prevention of mental health issues.The relationship of eMental Health Literacy to perceived barriers to receiving mental health services was examined in a sample of middle-aged and older adults.We hypothesized that higher eMental Health Literacy would predict fewer reported barriers to mental health services.A sample of 243 participants (M=63.33,range=55-80 years) were recruited online through Amazon Mechanical Turk to complete measures assessing eMental Health Literacy (eMHEALS) and mental health barriers (BMHSSS-R).After adding two correlated errors, a structural equation model specifying eMHEALS as a predictor of extrinsic and intrinsic barriers to mental health services achieved good fit (χ2(60)=170.014,p<.001, SRMR=.068,CFI=.944,GFI=.901,TLI=.927,RMSEA=.087).All indicators were significantly related to their latent construct (p<.001).The results indicate higher eMental Health Literacy significantly predicted fewer reported intrinsic and fewer extrinsic barriers to mental health services.These relationships were statistically significant even when examined across differing socioeconomic status and age.These findings indicate eMental Health Literacy may have significant impact on the way individuals in later life navigate through the mental healthcare system.

HEALTH CHARACTERISTICS AND TREATMENT PATTERNS OF VHA VETERANS DIAGNOSED WITH PTSD IN LATER LIFE Linh Dang, and Jenefer Jedele, Veterans Health Administration, Ann Arbor, Michigan, United States
Older adults may exhibit symptoms of Post-Traumatic Stress Disorder (PTSD) after a traumatic event, even if they do not meet the criteria for a full diagnosis.This sub-clinical PTSD affects 7-15% of older adults is associated with elevated depressive symptoms, suicidal ideation, and poorer physical health.Individuals with sub-clinical PTSD often experience worsening symptoms, resulting in a full diagnosis of PTSD, albeit late onset.This evaluation informs the Veterans Health Administration (VHA)'s understanding of the developmental course of PTSD in older Veterans.VHA administrative data were used to examine health characteristics and service utilization in the five years before and five years after the initial VHA documentation of PTSD.We identified a cohort of Veterans (n=27,610), alive and with at least 1 encounter in all evaluation years, with a first PTSD diagnosis documented between ages 50-59, a cohort outside of the average age of diagnosis, but before Medicare eligibility.We compared periods before and after diagnosis across different ages of first diagnosis (50)(51)(52)(53)(54)(55)(56)(57)(58)(59).Veterans diagnosed at later ages (55-59) had a greater number of mental and physical health conditions.Increasing VHA use preceded a PTSD diagnosis in both groups, but the increase was steeper among those diagnosed at 55-59.Future analyses will compare these patterns to those of Veterans diagnosed at younger ages.Findings from this work may provide a profile of persons at risk for late-life PTSD for use targeting interventions earlier to reduce the risk of developing worsening PTSD symptoms in late life.

IMPLEMENTING AN INTERDISCIPLINARY COMMITTEE TO REDUCE PSYCHOTROPIC DRUG AND INCREASE BEHAVIORAL INTERVENTION USE
Lauren Hess Conrad, 1 and David Portman, 2 1. Butler VA Health Care System, Pittsburgh, Pennsylvania, United States, 2. VA Butler Healthcare System, Butler, Pennsylvania, United States In Fiscal Year (FY) 2018, the Butler VA Health Care System's Psychotropic Medication and Behavior Management Committee was identified as a Veterans Integrated Service Network 4 Best Practice.The goal of this committee is to reduce unnecessary psychotropic medication use and polypharmacy and to increase behavioral intervention implementation among Community Living Center (CLC) Veterans.This committee meets quarterly to review Psychotropic Drug Safety Initiative data, behaviors and behavior care plans, and all psychotropic medications prescribed to Veterans.Psychiatric diagnoses, changes to psychotropic medications, and appropriate behavioral interventions are discussed.Committee members take responsibility for action items in accordance with their discipline; documentation of recommendations are made in quarterly behavioral health assessments in CPRS; and follow-up on action items is completed at twice weekly interdisciplinary treatment team meetings, weekly behavior rounds, and/ or as needed.From the first quarter (Q1) of FY16 to Q1 FY20, the Butler VA CLC has seen decreased prescriptions of 2 or more anticholinergics (6.6% to 0.80%), antihistamines (12.5% to 5.9%), benzodiazepines (24.7% to 11.0%), and benzodiazepines or sedative hypnotics (23.2% to 9.0%).While prescription of antipsychotic use has increased (Q1 FY20 = 23.8%), the committee will follow Long Term Care Institute guidelines for gradual dose reductions, behavioral interventions, and as needed psychotropic medication PRN use.This committee provides an interdisciplinary forum to discuss and implement beneficial changes to pharmacological and non-pharmacological interventions among all CLC Veterans.The committee is a valuable process for monitoring and reinforcing best practices that may be easily replicated across VA CLCs nationwide.

MARITAL RELIGIOUS HOMOGAMY AND DIMENSIONS OF WELL-BEING IN LATER LIFE: EVIDENCE FROM THE UNITED STATES
Laura Upenieks, 1 Markus Schafer, 2 and Jeremy Uecker, 3 1.University of Texas at San Antonio, San Antonio, Texas, United States, 2. University of Toronto,Toronto,Ontario,Canada,3. Baylor University,Waco,Texas,United States Past research points to the importance of couple-level religious similarity for multiple dimensions of older adults' partnership quality and stability, but we have a limited understanding of whether religious homogamy matters for the well-being of seniors.This study uses dyadic data from the National Social Life, Health, and Aging Project (NSHAP), a representative sample of 953 individuals ages 62-91 plus their marital or cohabiting partners.Using actor-partner interdependence models in the general structural equation model framework (GSEM), we find that religious attendance homogamy is beneficial for the physical health of men and the mental health and self-reported happiness of women.There were no associations between religious homogamy for religious importance detected.Taken together, our results attest to the ongoing importance of religious similarity-service attendance, in particular-for mental and physical well-being in later life.Future research is needed to more fully examine which mechanisms account for these patterns.

OBJECTIVE AND SUBJECTIVE COGNITIVE FUNCTION, AND RELATIONS WITH QUALITY OF LIFE AND PSYCHOLOGICAL DISTRESS
Hallie Nuzum, 1 Katherine Dorociak, 1 Shirit Kamil-Rosenberg, 1 Peter Louras, 2 Mandana Mostofi, 2 and J. Kaci Fairchild, 1 1.VA Palo Alto Healthcare System,Palo Alto,California,United States,2. Palo Alto University,Palo Alto,California,United States Objective and subjective cognitive function have been associated with decreased quality of life and increased psychological distress in older adults.The present study examined relations of objective and subjective cognition with quality-of-life and mental-health outcomes in individuals with amnestic mild cognitive impairment (aMCI).The sample included 98 older adults with aMCI (92.5% male, age = 70.9±9.2years).Measures included objective cognition (i.e., attention, memory, language, visuospatial abilities, processing speed, executive function, and overall), subjective memory (Multifactorial Memory Questionnaire [MMQ]), quality of life (Dementia Quality of Life [DQoL]), and mental health (Geriatric Depression Scale, Geriatric Anxiety Inventory, and Penn State Worry Questionnaire).Objective and subjective cognition were weakly correlated (range |r| = .00-.23).Objective cognitive measures were largely uncorrelated with quality of life or mental health, with only two significant (p < .05)correlations between Processing Speed