Recognizing the Needs of High-Need High-Risk Veterans

Abstract

Introduction: Understanding the needs of higher-risk older adult patients can support the delivery of high quality and patient-centered healthcare. We sought to characterize the physical, functional, social and psychological needs of High-Need High-Risk (HNHR) Veterans. We hypothesized that the concept of frailty could be useful in identifying the highest-risk HNHR patients and characterizing their needs. Methods: We conducted a cross-sectional study of Veterans in the Miami Veterans Affairs Healthcare System who were identified as High-Need High-Risk by the Department of Veterans Affairs (VA) using data analytic techniques. We analyzed data of 634 Veterans who completed questionnaires by mail, telephone or in person. We assessed the Veterans’ frailty status and needs in the physical, functional, psychological and social domains. Beyond descriptive statistics, we used Chi-square (χ2) test, one-way ANOVA and Kruskal–Wallis to analyze whether there were differences in Veterans’ needs in relation to frailty status. Results: The HNHR Veterans who participated in the questionnaire had complex needs that spanned the physical, functional, psychological, and social domains. We observed a potential mismatch between functional needs and social support; over two-thirds of respondents endorsed having dependence in at least one ADL but only about a third of respondents reported having a caregiver. Patients with frailty had higher levels of functional dependence and were more likely than the other HNHR respondents to report recent falls, recent hospitalizations, depression, and transportation issues. Conclusion: High-Need High-Risk Veterans have complex needs related to the physical, functional, psychological and social domains. Within the HNHR population, HNHR Veterans with frailty appear to have particularly high levels of risk and multidomain needs. Increased attention to identifying members of these groups and aligning them with biopsychosocial interventions that are targeted to their specific needs may support development of appropriate strategies and care-models to support HNHR Veterans.