Veterans with life-limiting illness: Initial baseline descriptors

Background: The US population is getting older, and the VA has long been a barometer for issues regarding aging, chronic illness and end-of-life care. The VA has a diverse and vulnerable veteran population which complicates management of seriously ill patients.

Methods: Data presented here come from a VA evaluation study of palliative case management for seriously ill veterans. Using a validated prognostication tool, medical residents identified eligible patients at index hospitalization. Veterans with life-limiting illness, who were cognitively intact and being discharged home were eligible.

Data presented here were collected from baseline face-to-face interviews conducted during index hospitalization. Veterans were asked demographic questions, asked to report difficulty with basic activities of daily living (ADLs) and were screened for depression. Respondents were also asked treatment preferences should their illness significantly worsen. Time period of data collection: 08/04-11/06; 400 in the final sample.

Results: Males comprised 97% of the sample. Forty-eight percent were white, 27% black, 11% Hispanic and 13% other. The sample mirrors the ethnic makeup of the local VA population. Mean age at enrollment was 63.4 years; 18% of the sample was 54 years or younger, 41% was between 55-64 years, 24% was between 65-74, and 17% was older than 75. Fifty-seven percent was single, 30% lived alone.

At baseline, approximately half of respondents (48-52%) reported some or much difficulty with basic ADLs: eating, dressing, and bathing. Forty-three percent screened positive for depression. While 260 patients had cancer as their primary life-limiting illness, 140 had non-cancer diagnoses (i.e. AIDS, COPD, Diabetes). To date, 222 patients have died.

Regarding treatment preferences, 74% would allow surgery requiring extended hospitalization, 22% would allow intubation, and 32% would accept tube feeding. Five to thirteen percent refused or were unable to answer these questions.

Discussion: There are many implications for veteran health policy development. This sample illustrates the diverse needs and preferences of a seriously ill veteran population.

A large portion of veterans were depressed; effective management of depression is important in improving quality of life during serious illness. Half the sample reported problems with basic ADLs, yet remained at home. Identifying needs and facilitating supportive in-home care can help veterans remain at home throughout their disease course, if desired. VA-wide implementation of programs that recognize treatment preferences and personal situations is critical for creating a tailored plan of care acceptable to patients, families, and providers.