Veteran Experience Center (VEC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Center for Health Equity Research and Promotion (CHERP), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; University of Pennsylvania, School of Nursing, Philadelphia, PA, USA.
Veteran Experience Center (VEC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Center for Health Equity Research and Promotion (CHERP), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
Healthc (Amst). 2021 Jun;9(2):100494. doi: 10.1016/j.hjdsi.2020.100494. Epub 2021 May 12.
In federal response to the aging population of Vietnam-era Veterans, Congress directed the Department of Veterans Affairs (VA) to create a pilot program to identify and develop best practices for improving hospice care for this population. A first step in VA's response was to identify whether the end-of-life (EOL) care needs and outcomes of Vietnam-era Veterans differed from previous generations.
Using medical records and bereaved family surveys, we examined clinical characteristics, healthcare utilization, and EOL quality indicators for Vietnam-era Veterans who died in VA inpatient settings between fiscal year 2013-2017. Contemporaneous comparisons were made with World War II/Korean War-era Veterans.
Compared to prior generations, higher percentages of Vietnam-era Veterans had mental health/substance use diagnoses and disability. Similar percentages of family members in both groups reported that overall EOL care was excellent; however, post-traumatic stress disorder management ratings by families of Vietnam-era Veterans were significantly lower.
Although current VA EOL practices are largely meeting the needs of Vietnam-era Veterans, greater focus on mental health comorbidity, including post-traumatic stress disorder, Agent Orange-related conditions, and ensuring access to quality EOL care in the community is warranted.
Policymakers and healthcare professionals should anticipate more physical and mental health comorbidities among Veterans at EOL as Vietnam-era Veterans continue to age. Findings are being used to inform the development of standardized EOL care protocols and training programs for non-VA healthcare providers that are tailored to the needs of this population.
为应对越战时期退伍军人的老龄化问题，美国国会指示退伍军人事务部（VA）制定一个试点计划，以确定并制定改善该人群临终关怀的最佳实践。VA 对此的初步反应是确定越战时期退伍军人的临终关怀需求和结果是否与前几代人有所不同。
我们使用病历和失去亲人的家庭调查，检查了在 2013 财年至 2017 财年期间在 VA 住院环境中去世的越战时期退伍军人的临床特征、医疗保健利用情况和临终关怀质量指标。与二战/朝鲜战争时期退伍军人进行了同期比较。
与前几代人相比，更高比例的越战时期退伍军人有心理健康/物质使用诊断和残疾。两个群体的家属报告临终关怀总体上都非常出色；然而，越战时期退伍军人的家属对创伤后应激障碍管理的评价明显较低。
尽管目前 VA 的临终关怀实践在很大程度上满足了越战时期退伍军人的需求，但仍需要更加关注心理健康共病，包括创伤后应激障碍、橙剂相关疾病，并确保在社区中获得高质量的临终关怀。
随着越战时期退伍军人的老龄化，政策制定者和医疗保健专业人员应预计临终时退伍军人会有更多的身体和心理健康共病。研究结果正在被用于为非 VA 医疗保健提供者制定标准化的临终关怀护理协议和培训计划提供信息，这些协议和培训计划针对该人群的需求进行了定制。
