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

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 services for older adults, health care, patient experience, psychosocial functioning, veterans What is known about this topic * Prior research has shown that patient-reported experiences are less favorable for individuals of younger age, female sex, lower education, lower socioeconomic status, and poorer selfrated health. * There is no consensus in the literature about why patient experiences differ by age. * Limited information exists regarding patient experiences of being asked about health goals, psychosocial concerns, and medications, and how these responses differ by age. What this study adds * Veterans ages 45-64 had a predicted probability of 71% for being asked about health goals, compared to 67% for Veterans age 65-r and 59% for age 18-44. * Veterans ages 65+ had a predicted probability of 45% for being asked about personal problems, compared to 57% of Veterans ages 45-64 and 59% 18-44. * Age disparities in discussing health goals and psychosocial needs during medical visits persisted after adjusting models for other characteristics known to be associated with disparities in patient experience, including sex, education, socioeconomic status, and health status.
1 | INTRODUCTION The U.S. veteran population is aging and will increasingly require ageappropriate care planning and delivery. Approximately 50% of veterans nationally and 47.1% of Veterans Health Administration (VA) [...]