The Relationship Between Covid-19 Anxiety and Well-Being Outcomes in Older Veterans

Abstract

Coronavirus disease 2019 (COVID-19) has had a devastating impact on older adult nursing home residents (NHR). NHRs comprise greater than one-third of COVID-19 U.S. deaths, emphasizing the importance of engaging in end-of-life discussions. At South Texas Veterans Health Care System (STVHCS), we implemented early documentation of patient’s Life-Sustaining Treatment (LST) or end-of-life goals-of-care preferences prior COVID-19 infection. We now aim to examine the association between early LST documentation (prior to COVID-19 diagnosis) and hospital admissions for COVID-19 by conducting a retrospective cohort study of Veteran NHRs at STVHCS from March 2020-January 2021. Inclusion criteria were NHRs with COVID-19 diagnosis, LST documentation, and clear timing of whether the LST documentation occurred before or after COVID-19 diagnosis. Logistic regression was used to determine the likelihood of hospitalization by whether LST was documented before or after COVID-19 diagnosis. 208 NHRs were diagnosed with COVID-19 and 160 (76.9%) had LST documentation. Of these, 148 were included in the analysis: 84 (56.8%) had a completed LST note prior to diagnosis and 64 (43.2%) after diagnosis. The hospitalization rate was 46% for those with LST prior to diagnosis compared to 78% in those with LST after diagnosis (OR = 0.24, 95% CI: 0.12-0.50, P<0.001), showing that early LST documentation was associated with 76% lower likelihood of hospitalization. Early interventions for LST documentation can reduce hospitalization in high-risk populations. These findings may have implications for reducing unnecessary hospitalizations, diminishing healthcare costs, and resolving ethical dilemmas related to potential resource allocation during a pandemic.

Arrests, Mental Health Outcomes, and Discharge Status in U.S. Military Veterans: A Latent Class Analysis

“…These new veterans must navigate a series of adjustments, including integrating into new communities, obtaining health care, and adapting to new cultural norms (Keeling, 2018). Although many veterans make an efficient and smooth transition out of the military, many also experience various challenges and barriers (Castro et al, 2014(Castro et al, , 2015Kintzle et al, 2016). During the transition process, veterans may find themselves unprepared to navigate unfamiliar non-military systems to meet crucial milestones, like accessing their earned U.S. Department of Veterans Affairs (VA) benefits, finding employment opportunities, managing financial challenges, and adjusting to civilian occupational and social expectations.…”