The Disablement Process of Aging United States Veterans

Florida State University, Tallahassee FL

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Abstract

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.