Posttraumatic Stress Disorder in Older Veterans admitted to VA Community Living Centers: Prevalence and Risk Correlates

Objectives: To examine prevalence and risk correlates for post-traumatic stress disorder (PTSD) occurring during or after admission to a Veterans Administration (VA) skilled nursing facility.

Design: Retrospective cohort analysis of electronic health record information extracted from the VA Corporate Data Warehouse.

Setting: United States VA skilled nursing facility.

Participants: 57,414 Veterans age 60+ with an admission during five fiscal years, 2018-2022, excluding those who died within six months of admission or were still admitted.

Measurements: The dependent variable was PTSD diagnosis during or six-months following the admission. Risk correlates examined were: age, gender, race, rurality, clinical complexity, prior dementia diagnosis, length of stay, and facility size; odds ratios (OR) and confidence intervals (CI) are provided for each correlate.

Results: 19.1% of Veterans had a diagnosis of PTSD, associated with younger age (age 60-69 compared to age 80+; OR: 2.92, 95% CI: 2.70-3.14; age 70-79 compared to age 80+ OR: 4.51, 95% CI: 4.20-4.84); female gender (OR: 1.65, 95% CI: 1.50-1.82); minoritized race (OR: 1.17, 95% CI: 1.12-1.23); higher clinical complexity (OR:1.22, 95% CI: 1.17-1.28). As compared to Veterans who had a prior PTSD diagnosis, Veterans with newly diagnosed PTSD were more likely to be older (age 60 group OR= 0.59, 95% CI:0.51-0.70; age 70 group OR= 0.54, 95% CI:0.46-0.62,), rural (OR=1.14, 95% CI:1.04-1.24) and admitted to a larger facility (OR=1.22, 95% CI:1.12-1.33).

Conclusions: PTSD is a significant concern for older Veterans admitted to VA skilled nursing facilities, supporting the need for trauma-informed care, particularly for those most at risk.