. U >3; -. i. . A w Veterans flflwfl Administration /Current Health Status and /the Future Demand for Health Care Programs and Social Support Services Follow-up Analyses From the Survey of Aging Veterans / SAV 70-85-3 Office of Information March 1985 Management and StatisticsA Statistical Policy and R eeeeee h Service Washington DC 20420 If: V if? ~ ‘ .3. I) l , ;,;:»;.;;;_m.:.zlz{; _, l 'V'" Current Health Status and the Future Demand for Health Care Programs and Social Support Services: Follow-up Analyses From the Survey of Aging Veterans Donald D. Stockford, M.A. Biometrics Division (712) Statistical Policy and Research Service Office of Information Management and Statistics Veterans Administration Washington, D.C. 20420 March 1985 73 36753 2 mm U 2» 36a 579» INTRODUCTION ' €35 €09, L This report presents information on the current health status of veterans aged 55 and over as it relates to their future demand for health care programs and social support services. In particular, the information in this report may be of use to VA health care planners who wish to correlate veterans' attitudes about their current health with veterans' future requirements for VA medical programs and services. This report is the fourth in a series of special studies based on data obtained from the 1983 Survey of Aging Veterans (SAV), l! which was conducted by Louis Harris and Associates, Inc. The Veterans Administration commissioned SAV in order to obtain information with which to assess the medical care needs, resources, and expectations of the aging veteran population. SAV was conducted as a national household survey of noninstitutionalized male and female veterans aged 55 and over. The survey resulted in a nationally representative sample of 3,013 veterans who provided information to interviewers not only on their current health status, but also on their general health conditions, health care usage patterns, and economic and social characteristics. Survey sample data contained in this report have been weighted to represent the 1983 target population of 11.8 million veterans in the 55 2/ and over age bracket. — CURRENT HEALTH STATUS Apart from age, which in itself is an indicator of aging veterans' current health status and potential health care needs, the Survey of Aging Veterans (SAV) provided several other measures of a veteran's current health status. The various measures correspond to different perspectives from which one can view the general health of veterans aged 55 and over. 1/ Veterans Administration. Office of Reports and Statistics. Survey of Aging Vet- erans: A Study of the Means, Resources, and Future Expectations of Veterans Aged 55 and Over. 3/ Veterans Administration. Office of Reports and Statistics. Veteran Population: September 30, 1983. Washington, D.C., December 1983. This report focuses on the two attitudinal measures of a veteran's current health status provided by SAV. The two attitudinal measures of current health status are the most global of the health status measures in SAV, and, in this report, the two measures are referred to as the veteran's "self-health rating" and the veteran's "health limitations." Since it is reasonable to assume that individuals' attitudes and opinions about their current health status are correlated with their future health care and social support needs and expectations, this report relates the two attitudinal measures of current health status to aging veterans' future demand for health care programs and social support services. The two attitudinal measures of current health status are shown to be consistent predictors in this regard. SELF-HEALTH RATINGS The self-health rating measure refers to the veteran's own opinion concerning his or her general health situation. The data on self-health ratings were obtained from item 12 of the SAV questionnaire. This survey question directed veterans to rate their health in relation to that of other persons in their own age group. Data 1/ from SAV on veterans' self-health ratings as a measure of current health status are shown in Table 1. The data of Table 1 show that in comparison with other persons their own age, 61% of all veterans aged 55 and over rated their health as good to excellent, while 39% rated their health as fair or poor. In particular, Table 1 shows that the percentage of veterans in the lowest (55-59) age group are the most likely to rate their health as good to excellent, whereas veterans in the 70-74 year and 75-and-over age groups are the least likely to rate their health as good to excellent. 1/ Data presented in this report exclude proxies and unknowns. The total number of proxies and unknowns varies from question to question in the SAV questionnaire. Thus, subtotals may differ from table to table in this report. Although the majority of veterans aged 55 and over reported their health as good to excellent, a large proportion of those veterans who rated themselves in such a way also reported that they experience health limitations. This point is discussed in more detail on page 6. TABLE 1 CURRENT HEALTH STATUS OF AGING VETERANS AS MEASURED BY SELF-HEALTH RATING (Percentage Distribution) Compared to persons their own age, vet- Age Group erans rated their health: All Ages 55-59 60-64 65-69 70-74 75 + over 1. Good to Excellent 61 66 60 59 55 57 2. Fair or Poor 39 34 40 41 45 43 All Ratings 100 100 100 100 100 100 (Base: Millions*) (11.5) (3.8) (3.7) (2.1) (1.0) (0.9) *Excludes proxies and unknowns. HEALTHJLIMITATIONS The "health limitations" measure refers to a veteran's current health in relation to his or her functional ability to do work and perform everyday tasks. The data on health limitations were obtained from items 13 and 14 of the SAV instrument. Data from SAV on current health status as measured by health limitations are shown in Table 2. Health limitations, as defined in Table 2, are always associated with disability or poor health. The data of Table 2 show that, among veterans aged 55 and over, nearly half (48%) said they experience health limitations of some sort as a result of disability or poor health; 25% said they experience health limitations and are kept from working (including housework) because of it; 17% said they are limited in the kind or amount of work they can do but are not kept from working; and 5% said they are limited in some way by disability or poor health, but are not kept from working, and are not limited in the kind or amount of work they can do. Overall, Table 2 shows that health limitations increase with age, as expected, and that these limitations are most prevalent among veterans aged 75 and over; fully two-thirds (68%) of veterans aged 75 and over experience limitations in their activities due to disability or poor health. Since there may be a causal relation- ship between health limitations and functional disabilities which could require medical care or social support services, these data suggest that veterans aged 75 and over comprise a special group whose health care and social support needs and expec— tations may differ considerably from those of veterans of any other age group. This finding is in line with the statement in a recent VA report 1/ that "the propor— tion of a population which is above age 75 is a very important factor in determining that population's total need for services." 1/ Veterans Administration. Department of Medicine and Surgery. Caring for the older Veteran: A Shared Vision for the Future. Washington, D.C. 1984. TABLE 2 CURRENT HEALTH STATUS OF AGING VETERANS AS MEASURED BY HEALTH LIMITATIONS (Percentage Distribution) Health Limitations Age Group All Ages 55-59 60—64 65-69 70—74 75 + over 1. Limited and kept from working 25 18 27 27 29 38 2. Limited in the kind or amount of work can do, but not kept from working 17 14 15 19 25 25 3. Limited but not kept from working and not limited in the kind or amount of work can do 5 6 5 7 3 5 Subtotal Limited 48 38 47 53 57 68 Subtotal Not Limited 52 62 53 47 43 32 Total 100 100 100 100 100 100 (Base: Millions*) (11.6) (3.8) (3.7) (2.2) (1.0) (0.9) *Excludes proxies and unknowns. SELF-HEALTH RATINGS AND HEALTH LIMITATIONS There is a relationship between veterans' self-health ratings and their health limitations which corroborates the conclusion of the last section concerning veterans aged 75 and over. This relationship is illustrated by the data in Table 3. The data of Table 3 were obtained from items 12-14 of the SAV questionnaire and show that even among those aging veterans whose self-health rating is good to ex- cellent, nearly one-quarter (24%) said that they experience health limitations. In particular, for veterans who reported good to excellent health, health limitations increase with age but are especially pronounced for veterans in the 75-and-over age group. Among those veterans aged 75 and over who reported their health as good to excellent, 43% said that their health limits their activities to some extent, while nearly all (95%) veterans in this age group who rated their health as fair or poor said that they experience health limitations. Due to the possible causal relation- ship between health limitations and functional disabilities requiring medical care or social support services, it is apparent that veterans aged 75 and over should be a focal group in terms of VA planning efforts for aging veterans. TABLE 3 HEALTH LIMITATIONS OF AGING VETERANS BY SELF-HEALTH RATING (percent of those with the given self-health rating who also reported health limitations) Compared to persons their own age, vet- Age Group erans rated their All Ages Base: health: All Age 55-59 60-64 65—69 70-74 75 + over Millions* 1. Good to Excellent 24 18 23 28 34 43 (7.0) 2. Fair or Poor 83 77 84 87 81 95 (4.4) *Excludes proxies and unknowns. DURATION OF HEALTH LIMITATIONS As health limitations are largely a function of age, one should expect older veterans (i.e., those at the upper end of the 55—and-over age bracket) to have experienced such limitations for a longer time than younger veterans (i.e., those at the lower end of the 55 and over age bracket). factor with respect to health limitations. item 15 of the SAV questionnaire. TABLE 4 DURATION OF HEALTH LIMITATIONS OF AGING VETERANS BY AGE (Percentage Distribution) Table 4 displays this time The data of Table 4 were obtained from *Excludes proxies and unknowns. Duration Age All Ages 55—59 60-64 65-69 70-74 75 + over (70 + over) 1. 0-5 Years 46 45 46 47 39 47 (43) 2. 6 Years or More 54 55 54 53 61 53 (57) All Years 100 100 100 100 100 100 (100) (Base: Millions*) (5.4) (1.4) (1.7) (1.1) (0.6) (0.6) ((1.2)) The data of Table 4 show that among veterans with health limitations, more than half (54%) said that these limitations have existed for six years or more. In fact, more than half of the veterans in each of the age groups of Table 4 reported having had health limitations for six years or longer. Thus, health limitations tend to be of considerable duration. Table 4 also shows that veterans in the 70-74 year age group reported having been limited for six years or more at a slightly higher rate (61%) than did veterans in the other age groups of the table. When the 70-74 and 75-and-over age groups are combined, Table 4 shows that veterans aged 70 and over, as a group, reported health limitations of six years duration or longer at a slightly higher rate (57%) than did veterans in the younger age groups of the table. That the difference between the older and younger age groups with respect to the duration of health limitations is not far greater may seem surprising. However, small sample sizes in the older age groups preclude a deeper analysis. In any case, these data suggest that not only do older veterans (i.e., those at the upper end of the 55-and-over age bracket) experience health limitations at a greater rate than younger veterans (i.e., those at the lower end of the 55-and-over age bracket), but that they also have endured their health limitations a bit longer. CURRENT HEALTH STATUS AND FUTURE DEMAND Data on aging veterans' future demand for health care programs and social support services were obtained from question 89 of the SAV instrument. Veterans were asked to identify those programs and benefits they would be likely to apply for within the next 10 years. Within the context of the question and the possible answers to it, two assumptions must be made: (1) that the programs and services referred to are VA-administered programs and services, and (2) that nothing should occur within the next decade to interfere with current or potential eligibility for and availability of those specific VA programs and services addressed in the question. Table 5 shows the survey results on future demand cross-classified by each of the two attitudinal measures of current health status. The data of Table 5 show that, regardless of either the self-health rating or the health limitations measure, the programs and services which approximately one-quarter or more of veterans aged 55 and over are most likely to apply for within the next 10 years include hospitalization and medical care for veterans aged 65 and over, VA outpatient treatment, pensions for wartime veterans aged 65 and over, nursing home care for veterans aged 65 and over, and dental care. Table 5 also shows that there will be considerable demand for hos- pitalization and medical care for low-income veterans as well as for hospitalization and medical care for disabled veterans. Furthermore, to examine the predictive ability of the two attitudinal measures of health status, one can compare the self—health rating of "good to excellent" with the health limitations rating of "not limited," and the self-health rating of "fair or poor" with the health limitations rating of "limited." Such a comparison shows that for any given program or service listed in Table 5, the respective paired percentages are the same or similar. This means that the two attitudinal measures of current health status are very closely correlated and are also consistent with respect to predicting future demand. TABLE 5 FUTURE DEMAND FOR PROGRAMS AND SERVICES BY CURRENT HEALTH STATUS OF AGING VETERANS (percent who said they would apply for the program or service within the next 10 years) Program or Service (Base: Mllllons*) 1. 2. 3. 4. 5. 6. 7. 8. 9. 11. 13. 14. 15. Hospitalization and medical care for veterans 65 + over VA outpatient treatment Pensions for war- time veterans 65 + over Nursing home care for veterans 65 + over Dental care Hospitalization and medical care for low-income veterans Hospitalization and medical care for disabled veterans Housebound supple- ment Aid and attendance supplement Compensation for disability result- ing from military service Domiciliary care Home loans Psychological coun— seling Drug and alcohol treatment Vocational rehabilitaq tion tralnlng for disabled veterans - Current Health Status - Self-Health Health Self Health Health Rating: Limitations: Rating: Limitations: All Good to Excellent Not Limited Fair or Poor Limited Ratings (7.1) (6.1) (4.5) (5.6) (11.6) 42 42 51 50 46 25 23 41 39 31 33 33 39 38 35 27 25 35 37 30 24 23 33 32 28 14 14 31 29 21 12 9 29 29 19 _9 7 15 16 12 6 5 12 12 8 4 3 12 12 7 5 4 7 8 6 7 7 5 5 6 2 2 3 3 2 * Excludes proxies and unknowns. 10 CONCLUSIONS According to the 1983 Survey of Aging Veterans: Most (61%) veterans aged 55 and over rated their health as good to excellent in comparison with other persons their own age. About half (48%) of all veterans aged 55 and over reported health limitations (i.e., limitations in their activities due to disability or poor health.) One-quarter of all veterans who rated their health as good to excellent in comparison with other persons their own age also reported that they experience health limitations. Most veterans who reported health limitations have endured their health limitations for six years or more. Veterans aged 75 and over comprise a special group whose health care needs and expectations may differ considerably from those of any other age group. Veterans aged 75 and over should probably be a focal group in terms of VA planning efforts for aging veterans. The two attitudinal measures of current health status discussed in this report (self-health ratings, health limitations) are consistent predictors of future demand. To obtain copies of this report, contact Ms. Ruby McCrae at (202) 389-3458. Inquiries concerning the content of the report should be directed to the author: Donald D. Stockford, M.A. Biometrics Division (712) Statistical Policy and Research Service Office of Information Management and Statistics Veterans Administration 810 Vermont Avenue, N.W. Washington, D.C. 20420 Telephone: (202) 389-2874 11 Other reports previously issued in this/series: The Aging Female Veteran (SAV 70—84-1), September 1984. Health Insurance Coverage Among Veterans Aged 55 and Over (SAV 70-85-1), January 1985. National Cemetery and Headstone/Marker Programs (SAV 70-85-2), February 1985. U.S. GOVERNMENT PRINTING OFFICE 1985: 461-890/24991 12 GENERAL LIBRARY - 0.0. BERKELEY 0000509553 Vomrra Adminiltration Current Health Status Office of information and the Futur- Demand Management and Statistics for Health Cara Programs Statisticai Poiicy and and Sociai Support ‘, Research Service ' Sonic» Washington DC 20420 March 1985