Article

Substance Use Disorders and Health Care Costs Among Veterans Affairs Nursing Home Residents

Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, CA, USA.
Medical care (Impact Factor: 2.94). 03/2011; 49(6):538-44. DOI: 10.1097/MLR.0b013e318207f257
Source: PubMed

ABSTRACT Research on the relationship between substance use disorders (SUDs) and older adults' health care costs is equivocal. A large-scale study comparing health care costs among older adults with and without SUDs has never been conducted.
To determine the relation of SUDs to health care costs in a large sample of adults following entry into a Veterans Affairs (VA) nursing home.
We performed a retrospective analysis of 29,997 adults aged 45+ who entered a VA nursing home in 2000. Total costs were tallied over fiscal years 1997 to 2000 by setting (outpatient, nursing home, other inpatient, and total) and included all care paid by VA.
Relative to non-SUD patients, those with SUDs aged 75 to 84 years had significantly higher total costs of care (+$10,020), as did those aged 85 and above (+$16,052). Yet, SUD diagnosis was not a significant predictor of total cost or nursing home cost among persons 65 and above after controlling for demographic, clinical, and financial factors.
SUDs do not directly increase health care costs among older adults entering nursing homes, although they may affect cost of care indirectly through factors such as income and marital dissolution. The generational increase in SUD rates occurring in the United States may not lead to substantially greater health care expenses if appropriate assistance can be provided before nursing home entry.

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    ABSTRACT: We conducted a systematic literature review on substance misuse, abuse, and dependence in women veterans, including National Guard/reserve members. We identified 837 articles published between 1980 and 2013. Of 56 included studies, 32 reported rates of alcohol misuse, binge drinking, or other unhealthy alcohol use not meeting diagnostic criteria for abuse or dependence, and 33 reported rates of drug misuse or diagnosed alcohol or drug use disorders. Rates ranged from 4% to 37% for alcohol misuse and from 7% to 25% for binge drinking; among Veterans Health Administration (VA) health-care system outpatients, rates ranged from 3% to 16% for substance use disorder. Studies comparing women veterans and civilians reported no clear differences in binge or heavy drinking. Substance misuse rates were generally lower among women veterans than men veterans. Substance misuse was associated with higher rates of trauma, psychiatric and medical conditions, and increased mortality and suicide rates. Most studies included only VA patients, and many used only VA medical record data; therefore, the reported substance misuse rates likely do not reflect true prevalence. Rates also varied by assessment method, source of data, and the subgroups studied. Further efforts to develop epidemiologically valid prevalence estimates are needed to capture the true health burden of substance misuse in women veterans, particularly those not using VA care. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.
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