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“Multimorbidities: Age-Related Relationships among Medical Disorders, Psychiatric Disorders, Substance Use Disorders, and Psychotropic Prescriptions in the U.S. Veteran Population”
2016 AAGP Annual Meeting number of ways usual activities were changed for both the depressed (r = .44, p < .01) and non-depressed (r = .47, p < .01). Perceived stress was also correlated with PHQ-9 scores (r = .34, p < .01). A regression model predicting perceived stress showed that clinically significant depression interacted with number of ways individuals were impacted by Sandy (β = -.10, p < .01), indicating that those with clinically significant depression experienced more perceived stress due to fewer hurricane-related effects. The same result was also found in the model predicting perceived stress with number of activity changes whereby those with clinical depression experienced higher stress from fewer activity changes (β = -.10, p < .01). Conclusions: These results suggest that older adults with clinically significant depression may experience more stress as a result of fewer negative effects of natural disasters. The results of this study could potentially inform citywide disaster preparedness plans that target older adults based on their level of vulnerability to the impacts of natural disasters with the goal of mitigating the stress levels experienced by this population.
Poster Number: EI 44
“Multimorbidities: Age-Related Relationships among Medical Disorders, Psychiatric Disorders, Substance Use Disorders, and Psychotropic Prescriptions in the U.S. Veteran Population” Luming Li, MD1,2; Paul D. Kirwin, MD1,2; Robert Rosenheck, MD3,1 1
Yale University Department of Psychiatry, New Haven, CT VA Connecticut Health Care System, West Haven, CT 3 VA New England Mental Illness, Research, Education and Clinical Center, West Haven, CT 2
Introduction: Multimorbidity is the co-occurence of multiple chronic illnesses in the same individual (Fortin, Stewart, Poitras, Almirall, & Maddocks, 2012). Since multimorbidity affects more than 50% of people with at least one chronic illness, understanding multimorbidity has been an important area of research in recent years (Tinetti, Fried, & Boyd, 2012). Notably, researchers have found that multimorbidity has been associated with disability, poor quality of life, and high health care utilization (Egede et al., 2015; Fortin et al., 2004; Yoon, Zulman, Scott, & Maciejewski, 2014; Zulman et al., 2015). Multimorbidity is an important topic since it impacts healthcare spending, patient outcomes, and patient experiences with illness. Studies so far have reported that people who are older have increased total numbers of conditions compared to younger age groups (Marengoni et al., 2011). In addition, studies have shown that diagnoses such as diabetes, HIV, and heart disease are linked to depression and other mental illnesses (Boutayeb, Boutayeb, & Boutayeb, 2013; Emerging Risk Factors et al., 2015; Findley, Shen, & Sambamoorthi, 2011; Fisher, Chan, Nan, Sartorius, & Oldenburg, 2012; Gill, Chen, & Lieberman, 2008; Glynn, 2009). Many of these studies link comorbidities between individual diagnoses, with few studies identifying large, associative trends for multiple co-occuring medical, psychiatric and/or addictive disorders. Substance use disorders are not typically studied as a separate category of illness. To our knowledge, no study has assessed the associative trends of medical, psychiatric, and substance use disorder multimorbidities in a veteran population, although studies have linked veterans to having higher rates of substance use and post-traumatic stress disorder alongside medical comorbidities (Findley et al., 2011; Steinman et al., 2012; Zulman et al., 2015). Returning veterans have unique risk factors for psychiatric, substance use, and medical illnesses following military exposure, assessing the early and late-life multimorbidity patterns is warranted. Methods: In this study, encounter claims from a national Veterans Health Administation (VHA) database are used to characterize age-related trends and relationships among 24 medical diagnoses, 10 psychiatric diagnoses, and 8 substance use disorders. In addition, we assessed prescription patterns of commonly used psychiatric medications. The sample includes all outpatients who used the VHA during the fiscal year (FY) 2012 (January 1, 2011–December 31, 2012) which totaled 5.3 million veterans nationally. Demographic and diagnostic data were obtained from encounter claims data, and number of prescriptions filled using the Decision Support System pharmacy file. Measures were obtained from medical diagnoses including the 24 in the Charlson co-morbidity index. Ten psychiatric diagnoses and eight substance use diagnoses were also included. Six classes of psychiatric prescriptions were used. Sociodemographic data used in this study included age, which was categorized as: 40 and below, ages 41–54, ages 55–64, ages 65–74, ages 75–84, and 85 and greater. Multimorbidity was defined as the average number of diagnoses in each of the 3 categories. The mean number of diagnoses per patient on each measure was graphically examined by age group, along with correlation coefficients to assess how strongly these measures of co-morbidity related to one another. In addition, the total number of psychiatric medications per age group was identified, and means were calculated for the average number of prescriptions per age group. Correlation data was also calculated for psychiatric prescriptions as related to substance use disorders, psychiatric disorders, and medical diagnoses. The statistical significances for all identified means and correlational data showed an x < 0.0001. Results: The total number of medical diagnoses generally increases with age, but the total number of psychiatric and substance use disorders decreases or with age. Figure 1 shows the decreasing trend of substance use and psychiatric diagnoses, with an increase in medical diagnoses until the curve plateaus. We also report an age-related decrease in common psychiatric
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Am J Geriatr Psychiatry 24:3, Supplement 1
2016 AAGP Annual Meeting Figure 1.
Multimorbidity in different age groups of psychiatric (PSYCH 10), medical (MED 24), and substance use (Drug 8) disorders.
Figure 2.
Correlations between medical & substance use disorders (CORR MED DRUG), psychiatric & substance use disorders (CORR PSY DRUG), and medical & psychiatric disorders (CORR PSY MED).
medication prescriptions (not shown in figures). Figure 2 shows that the correlation diminishes between psychiatric and substance use disorders as age increases. In addition, the correlational relationship between medical and psychiatric disorders was relatively stable with age increases. These findings show that psychiatric and medical conditions are more closely related than psychiatric and substance use disorders in an aging national veteran population. Conclusions: Through this work, we have identified useful epidemiological and prevalence data about age-related multimorbidities and psychiatric prescribing trends in VHA service users in the United States.
Am J Geriatr Psychiatry 24:3, Supplement 1
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Poster Number: EI 44
“Multimorbidities: Age-Related Relationships among Medical Disorders, Psychiatric Disorders, Substance Use Disorders, and Psychotropic Prescriptions in the U.S. Veteran Population” Luming Li, MD1,2; Paul D. Kirwin, MD1,2; Robert Rosenheck, MD3,1 1
Yale University Department of Psychiatry, New Haven, CT VA Connecticut Health Care System, West Haven, CT 3 VA New England Mental Illness, Research, Education and Clinical Center, West Haven, CT 2
Introduction: Multimorbidity is the co-occurence of multiple chronic illnesses in the same individual (Fortin, Stewart, Poitras, Almirall, & Maddocks, 2012). Since multimorbidity affects more than 50% of people with at least one chronic illness, understanding multimorbidity has been an important area of research in recent years (Tinetti, Fried, & Boyd, 2012). Notably, researchers have found that multimorbidity has been associated with disability, poor quality of life, and high health care utilization (Egede et al., 2015; Fortin et al., 2004; Yoon, Zulman, Scott, & Maciejewski, 2014; Zulman et al., 2015). Multimorbidity is an important topic since it impacts healthcare spending, patient outcomes, and patient experiences with illness. Studies so far have reported that people who are older have increased total numbers of conditions compared to younger age groups (Marengoni et al., 2011). In addition, studies have shown that diagnoses such as diabetes, HIV, and heart disease are linked to depression and other mental illnesses (Boutayeb, Boutayeb, & Boutayeb, 2013; Emerging Risk Factors et al., 2015; Findley, Shen, & Sambamoorthi, 2011; Fisher, Chan, Nan, Sartorius, & Oldenburg, 2012; Gill, Chen, & Lieberman, 2008; Glynn, 2009). Many of these studies link comorbidities between individual diagnoses, with few studies identifying large, associative trends for multiple co-occuring medical, psychiatric and/or addictive disorders. Substance use disorders are not typically studied as a separate category of illness. To our knowledge, no study has assessed the associative trends of medical, psychiatric, and substance use disorder multimorbidities in a veteran population, although studies have linked veterans to having higher rates of substance use and post-traumatic stress disorder alongside medical comorbidities (Findley et al., 2011; Steinman et al., 2012; Zulman et al., 2015). Returning veterans have unique risk factors for psychiatric, substance use, and medical illnesses following military exposure, assessing the early and late-life multimorbidity patterns is warranted. Methods: In this study, encounter claims from a national Veterans Health Administation (VHA) database are used to characterize age-related trends and relationships among 24 medical diagnoses, 10 psychiatric diagnoses, and 8 substance use disorders. In addition, we assessed prescription patterns of commonly used psychiatric medications. The sample includes all outpatients who used the VHA during the fiscal year (FY) 2012 (January 1, 2011–December 31, 2012) which totaled 5.3 million veterans nationally. Demographic and diagnostic data were obtained from encounter claims data, and number of prescriptions filled using the Decision Support System pharmacy file. Measures were obtained from medical diagnoses including the 24 in the Charlson co-morbidity index. Ten psychiatric diagnoses and eight substance use diagnoses were also included. Six classes of psychiatric prescriptions were used. Sociodemographic data used in this study included age, which was categorized as: 40 and below, ages 41–54, ages 55–64, ages 65–74, ages 75–84, and 85 and greater. Multimorbidity was defined as the average number of diagnoses in each of the 3 categories. The mean number of diagnoses per patient on each measure was graphically examined by age group, along with correlation coefficients to assess how strongly these measures of co-morbidity related to one another. In addition, the total number of psychiatric medications per age group was identified, and means were calculated for the average number of prescriptions per age group. Correlation data was also calculated for psychiatric prescriptions as related to substance use disorders, psychiatric disorders, and medical diagnoses. The statistical significances for all identified means and correlational data showed an x < 0.0001. Results: The total number of medical diagnoses generally increases with age, but the total number of psychiatric and substance use disorders decreases or with age. Figure 1 shows the decreasing trend of substance use and psychiatric diagnoses, with an increase in medical diagnoses until the curve plateaus. We also report an age-related decrease in common psychiatric
S108
Am J Geriatr Psychiatry 24:3, Supplement 1
2016 AAGP Annual Meeting Figure 1.
Multimorbidity in different age groups of psychiatric (PSYCH 10), medical (MED 24), and substance use (Drug 8) disorders.
Figure 2.
Correlations between medical & substance use disorders (CORR MED DRUG), psychiatric & substance use disorders (CORR PSY DRUG), and medical & psychiatric disorders (CORR PSY MED).
medication prescriptions (not shown in figures). Figure 2 shows that the correlation diminishes between psychiatric and substance use disorders as age increases. In addition, the correlational relationship between medical and psychiatric disorders was relatively stable with age increases. These findings show that psychiatric and medical conditions are more closely related than psychiatric and substance use disorders in an aging national veteran population. Conclusions: Through this work, we have identified useful epidemiological and prevalence data about age-related multimorbidities and psychiatric prescribing trends in VHA service users in the United States.
Am J Geriatr Psychiatry 24:3, Supplement 1
S109