Anticipated Impacts on Veteran's Healthcare: The 2008 VA State of the Art Conference, 'The Changing Faces of Geriatrics and Extended Care: Meeting the Needs of Veterans in the Next Decade' addresses the complex challenges associated with the growing number of aging veterans, including the impact of dementia diagnoses on the provision care in the of GEC service line. By examining the feasibility of using life-review methodology with veterans in the Birmingham Veteran Affairs Medical Center (BVAMC) Memory Clinic and the Geriatric Assessment Clinic, the VA may be better positioned to explore the subjective experience of veterans with early-stage dementia. This endeavor has the potential to contribute to characterizing the complex psychosocial needs of this population and developing psychosocial interventions targeting such needs. Such interventions may reduce utilization of services and improve quality of life for veterans and caregivers. Project Background: Dementia is a prevalent condition among older adults, with the incidence expected to increase as the cohort of baby boomers ages. Among veterans, dementia diagnoses and dementia-related health care utilization varies by VISN. From fiscal year 1997 to the first 6 months of fiscal year 2001, the frequency of dementia diagnoses for veterans age 65 years and older ranged from a low 5.8% in VISN 3 to a high of 9.4% in VISN 7, which includes the BVAMC. Compared to other VA patients over 65, veterans with dementia averaged higher utilization of outpatient psychiatry services and inpatient services, with more hospital stays, discharges, acute bed days, as well as longer lengths of stay. Project Objectives: The objectives of this study are to: (a) test the feasibility of using a life- review methodology to conduct face-to-face life recall sessions with veterans diagnosed with early-stage dementia in the BVAMC outpatient Memory Assessment Clinic and Geriatric Assessment Clinic, (b) evaluate the utility of the project's life-review data for developing interventions targeting the specific needs of this patient population, (c) seek feedback from participants regarding participation in research using life-review methodology, and (d) seek feedback from caregivers concerning the impact of the life-review process on the patient and family. Project Methods: To achieve these objectives, we will use a life-review method developed by Hospice Foundation of America. We will conduct face-to-face life-review sessions in the BVAMC Memory Assessment Clinic and Geriatric Assessment Clinic with a total of 10 early- stage dementia outpatients (Dementia ICD Code 294.8). Although the ability to acquire new information is impaired in early stage dementia, the ability to recall information from the past is not likewise affected. Sessions will be audio-recorded onto cassettes using a VA approved recorder-transcription machine. Transcribed data will be downloaded into NVivo, a computer software program for storing, coding, analyzing, and interpreting non-numerical data. Study participants will be given a transcribed copy of the life review for personal use and as a legacy for family members.
Dementia is a prevalent condition among older adults. From fiscal year 1997 to the first 6 months of fiscal year 2001, the frequency of dementia diagnoses for veterans age 65 years and older ranged from a low 5.8% in VISN 3 to a high of 9.4% in VISN 7, which houses the Birmingham Veterans Affairs Medical Center (BVAMC). This project will evaluate the feasibility of using a life review process as a psychosocial intervention for older adult veterans diagnosed with early stage dementia in the BVAMC Geriatric Assessment Clinic and Memory Assessment Clinic. This is an innovative approach which has the potential to enhance the quality of life of veterans and their caregivers and reduce both costly outpatient and impatient health care utilization. If feasible, the life review process could be implemented in other VAMCs and expand the range of services offered to this patient population and their caregivers.
