Differences in End-of-Life Outcomes Among Older Military Veterans

Background and Purpose: By the year 2024, the number of older veterans in the United States is projected to increase, comprised primarily of Vietnam-era veterans, Korean-era veterans and Gulf-war era veterans. With the population of aging veterans increasing, several researchers have identified the impact of military experience on the aging process, including the influence of military culture on health behaviors and consequently, health outcomes. Considering the unique experiences of older veterans, the purpose of this study was to examine differences in experiences at the end of life between older veterans and older nonveterans. Specifically, this study evaluated differences in place of death, hospice use, anxiety and depression at the end of life and the experience of pain at the end of life.

Methods: The sample was derived from the 2012 to 2018 National Health and Aging Trends Study (NHATS), an annual panel survey of Medicare beneficiaries living in the United States (N=2,539). The NHATS is conducted by the Johns Hopkins School of Public Health and is funded by the National Institute on Aging. For individuals who die between each year, a last month of life survey is administered to a proxy who is often a family member, friend, or individual familiar with the decedent. Chi-square tests were used for bivariate analyses and multivariate logistic regression models were used to predict each dependent variable based on veteran status.

Results: After controlling for confounding factors, older veterans were less likely to die at home (OR=.783, CI=.779-.786), less likely to have hospice care (OR=.874, CI=.870-.877), more likely to experience anxiety and depression (OR=1.134, CI=1.129-1.138), and more likely to experience pain (OR=1.289, CI=1.283-1.295) at the end of life compared to nonveterans.

Conclusions and Implications: The results of this study suggest that older veterans are experiencing worse end-of-life outcomes compared to their nonveteran peers. Prior studies have shown that veterans often delay health care, are hesitant to use mental health services and are more likely to suppress the experience of pain. These military-related factors may therefore contribute to end-of-life outcomes among veterans, leading to a lower quality of life at the end of life. As such, interventions should aim to improve communication between providers and veterans at the end of life, with a focus on enhancing provider military cultural humility and encouraging help-seeking among veterans both during and at the end of life. Additional implications for research, practice and policy are discussed.