THE DEPARTMENT of Veterans Affairs Health Care System (VA) is a federally funded integrated system of care, with about 5% of the total market share for hospital services.¹ It serves a select group of veterans, with complex health care needs. Compared with veterans nationally and the general US population, users of the VA health care system not only have disabilities that are connected to their military service but they are also older, poorer, less educated, and sicker with more disease.^2,3 Lessons learned from the VA can provide a model for monitoring the outcomes of care in other managed care systems, especially those serving older populations. Like other health care systems that are seeking to adapt to a changing health care environment, the VA needs information about the health of current and prospective patients to anticipate patient demand, design effective services, and evaluate the outcomes of its care. The information that the VA has at hand to guide providers of care, administrators, and policymakers regarding ambulatory care is limited. In response to these needs, the Veterans Health Study (VHS) was developed to implement and demonstrate the use of monitoring patient-derived measures of functional status in the VA.

Change in life satisfaction was modeled over a 22-year period in 1,927 men. A curvilinear relationship emerged. Growth-curve models indicated that life satisfaction peaked at age 65 and then declined, but showed significant individual differences in rate of change. Extraversion predicted variability in change, with higher levels associated with a high and flat life satisfaction trajectory. Time-varying physical health and marital status were associated with higher life satisfaction. Proximity to death was associated with a decline in life satisfaction. On measurement occasions that were within 1 year before death, trajectories showed steeper decline, and this effect was not attributable to declines in self-rated physical health. The findings are at odds with prior (cross-sectional) research showing that subjective well-being improves with aging.

A peer-reviewed open access journal published by the National Institute of Environmental Health Sciences

We investigated the relations between plasma concentrations of homocysteine and vitamins B-12 and B-6 and folate, and scores from a battery of cognitive tests for 70 male subjects, aged 54-81 y, in the Normative Aging Study. Lower concentrations of vitamin B-12 (P=0.04) and folate (P=0.003) and higher concentrations of homocysteine (P=0.0009 ) were associated with poorer spatial copying skills. Plasma homocysteine was a stronger predictor of spatial copying performance than either vitamin B-12 or folate. The association of homocysteine with spatial copying performance was not explained by clinical diagnoses of vascular disease. Higher concentrations of vitamin B-6 were related to better performance on two measures of memory (P=0.03 and P=0.05). The results suggest that vitamins (and homocysteine) may have differential effects on cognitive abilities. Individual vitamins and homocysteine should be explored further as determinants of patterns of cognitive impairment.

Research from JAMA Psychiatry — Prospective Study of Posttraumatic Stress Disorder Symptoms and Coronary Heart Disease in the Normative Aging Study

To advance an intraindividual life-span approach to the issue of stability and change, we studied personality trait trajectories in adulthood. Growth curves for extraversion and neuroticism were estimated for over 1,600 men (initially aged 43–91) in the Normative Aging Study, who were followed over 12 years. We found significant individual differences in intraindividual change for both traits, as well as different trajectories for extraversion and neuroticism. The overall extraversion trajectory was best defined by a linear model, but neuroticism was characterized by quadratic decline with age. We then considered several variables as predictors of individual differences around these overall trajectories. Birth cohort, marriage or remarriage, death of spouse, and memory complaints were all significant predictors, explaining variability in both level and rate of personality trait change. These findings suggest that there is a good deal of variability in personality trajectories, and that some of this variability can be explained by birth cohort as well as by age-graded life events.