Provider discussion of health goals and psychosocial needs: Comparing older to younger veteran experience

Abstract

Objective: To examine by age, the veterans' report on whether components of age-friendly health systems were discussed during primary care visits.

Data sources and study setting: Veterans Affairs (VA) Survey of Healthcare Experience of Patients from October 2015 to September 2019.

Study design: Cross-sectional survey of VA users by age group (18-44 years, 45-64 years, 65+ years; N = 1,042,318). We used weighted logistic regression models to evaluate disparities in whether veterans discussed with anyone in their provider's office: health goals, depression symptoms, stress, personal problems, and medications. Models were adjusted for socio-demographic characteristics (sex, socioeconomic status, education, rurality) and comorbidity.

Data collection/extraction method: Surveys were administered by mail and online. Additional veteran characteristics were extracted from VA administrative data.

Principal findings: In unadjusted analyses, VA users age 18-44 had a higher (-8.2%; CI: -9.0, -7.3) and users aged 45 to 64 had lower (4.0%; CI: 3.7, 4.3) predicted, probably discussing health goals compared to age 65+. Fewer VA users age 65+ reported discussing depression symptoms, personal problems, and stress than other age groups, whereas more VA users age 65+ discussed medications. Results were unchanged after adjusting for socio-demographics and comorbidity.

Conclusions: Delivery of goal-concordant care relies on understanding the needs of individual patients. Lower rates of discussing what matters and mood represent potential missed opportunities to deliver age-friendly care for older veterans.

Keywords: geriatrics; goal concordance; health care; health services for older adults; patient experience; psychosocial functioning; veterans.

FIGURE 1

Unadjusted differences in discussion of outcomes compared to the 65+ age group. Positive values indicate that an age group had a higher predicted probability of achieving the outcome compared to the 65+ group. Negative values indicate that an age group had a lower predicted probability of achieving the outcome compared to the 65+ group. [Color figure can be viewed at wileyonlinelibrary.com]