The Disablement Process of Aging United States Veterans

美国退伍军人老龄化致残过程

• 批准号: 9755291
• 负责人: Stephanie Urena
• 金额: $ 0.95万
• 依托单位: FLORIDA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9755291
• 关键词: Accounting; Address; Adult; Age; Aging; Cessation of life; Characteristics; Childhood; Chronic; Chronic Disease; Computer software; Data; Data Analyses; Disease; Distal; Elderly; Growth; Health; Health Care Costs; Health and Retirement Study; Knowledge; Life; Life Expectancy; Life Experience; Literature; Long-Term Care; Mentors; Methods; Military Personnel; Modernization; Nature; Outcome; Policies; Population; Populations at Risk; Prevention; Process; Research; Sampling; Services; Severities; Surveys; Time; United States; Veterans; Vietnam; War; age related; base; cohort; combat; development policy; disability; experience; health data; health disparity; health equity; human old age (65+); improved; insight; mortality; mortality risk; physical conditioning; therapy development

Project Summary Older United States veterans are a population at risk for disability due to their early life experiences with military service and increasing age, and they may experience more physical health difficulties compared to civilians. Military service was a normative part of early adult life for today’s older U.S. population. The number of veterans aged 65 and older in the U.S. in 2015 was 9.3 million, and that number is projected to rise as veterans of the Vietnam War continue to age. Despite the lived experience and substantial number of older veterans, the details of their late life disability experience are not well understood. One major obstacle in the field is that non-random selection into the military biases the effects of early life military service on long term disablement processes and mortality, making it difficult to accurately pinpoint the mechanisms explaining the mixed findings in the literature. It is unclear if the key lies in the difference in the type and severity of chronic conditions, the nature of disablement and its progression over time, the mortality risk related to disease and disability, specific service related experiences, or a combination of these. To address these issues, the proposed project will first account for non-random selection forces into military service using propensity score matching. Then, I will determine how chronic conditions influence late life disability processes and mortality among veterans and civilians at the population level, and how service related experiences of veterans may fuel disparities. Data for this project come from the nationally representative, longitudinal Health and Retirement Study, which includes information on chronic conditions, disability, mortality, pre-service (childhood) characteristics, and past military service, including the 2013 Veteran Mail Survey (VMS) data supplement on veteran military experiences. After non-random selection into the military is accounted for, Aim 1 will assess how chronic conditions differentially impact the process of disablement of veterans over time compared to civilians using latent growth curves (LGC), including analysis of effects on timing and accumulation of disability using latent growth curves with random onset (LGCRO). Aim 2 will determine the overall effect and timing of chronic conditions and disability on mortality in later life for veterans and civilians by treating a binary mortality variable as a distal outcome of the chronic condition and disability trajectories. Aim 3 will re-examine the components of the disablement process most salient to veteran/civilian disparities (identified in Aims 1 and 2) to determine if service related experiences are implicated in poor health processes among older veterans. This will be accomplished by comparing the veteran subsample in the VMS to a matched, random sample of civilians within the core HRS, using LGCs and traditional regression methods. Results from the study will provide insight into the disablement process, mortality, and the factors contributing to health disparities, with the intent to inform intervention development and policy decisions that can improve the overall health equity of U.S. veterans.

项目摘要 美国老年退伍军人由于早年生活经历， 服兵役和年龄的增长，他们可能会遇到更多的身体健康问题相比， 平民对于今天的美国老年人来说，服兵役是早期成年生活的一个规范部分。的 2015年，美国65岁及以上的退伍军人人数为930万，预计这一数字将在2015年达到1000万。 随着越战老兵的不断老龄化，尽管生活经验和大量的数字 在老年退伍军人中，他们晚年残疾经历的细节不太清楚。一个主要 这个领域的一个障碍是，非随机选择进入军事偏见的影响，早期生活的军事 长期残疾过程和死亡率的服务，难以准确地确定 解释文献中混合结果的机制。目前还不清楚关键是否在于 慢性病的类型和严重程度，残疾的性质及其随时间的进展， 与疾病和残疾相关的死亡风险、与特定服务相关的经历，或 这些.为了解决这些问题，拟议的项目将首先考虑非随机选择力， 使用倾向分数匹配的军事服务。然后，我将确定慢性疾病如何影响 在人口水平上，退伍军人和平民的晚年残疾过程和死亡率，以及如何 退伍军人的服役经历可能会加剧差距。该项目的数据来自全国 具有代表性的纵向健康和退休研究，其中包括关于慢性病的信息， 残疾，死亡率，服役前（儿童）特征和过去的兵役，包括2013年 退伍军人邮件调查（VMS）数据补充退伍军人的军事经验。非随机选择后 考虑到进入军队，目标1将评估慢性病如何不同地影响这一过程， 使用潜在增长曲线（LGC），与平民相比，退伍军人随时间的残疾情况，包括 用随机起始的潜伏生长曲线分析残疾的时间和累积效应 （LGCRO）.目标2将确定慢性病和残疾对死亡率的总体影响和时间 在退伍军人和平民的晚年生活中，通过将二元死亡率变量视为 慢性病和残疾轨迹。目标3将重新审查残疾的组成部分 对退伍军人/平民差异（在目标1和2中确定）最突出的过程，以确定是否与服务有关 老年退伍军人的健康状况不佳与他们的经历有关。这将通过 将VMS中的退伍军人子样本与核心中的匹配的随机平民样本进行比较 HRS，使用LGC和传统回归方法。这项研究的结果将提供深入了解 残疾过程、死亡率和造成健康差距的因素， 干预发展和政策决定，可以改善美国退伍军人的整体健康公平性。

项目成果

The Impacts of Service Related Exposures on Trajectories of Mental Health Among Aging Veterans.

服务相关暴露对老年退伍军人心理健康轨迹的影响。

• DOI: 10.1093/geronb/gbw149
• 发表时间: 2018
• 期刊: The journals of gerontology. Series B, Psychological sciences and social sciences
• 作者: Ureña,Stephanie;Taylor,MilesG;Kail,BenLennox
• 通讯作者: Kail,BenLennox