Abstract
Background
Older rural veterans account for a significant proportion of VA health care costs (West & Weeks 2009). Cognitive impairment is increasingly prevalent among older adults. The lack of specialty services in rural settings is a significant barrier in addressing cognitive syndromes and providing quality care.
Methods
Rural dwelling Veterans were identified and screened for memory deficits with the Montreal Cognitive Assessment (MoCA). Scores in the impaired range were referred for formal neurological evaluation. This evaluation included the neurological, health education and social work assessments. Participants were screened with the Risk Assessment tool, which assesses six areas: legal/financial, safety, physical debility and falls, mood and unnecessary functional decline, social isolation, and care crises.
Results
This analysis evaluates 301 clients. The majority (95%, n=285) of the clients were male. Age ranged from 24 to 94 with the average age of 70. (See table 1). The most common diagnosis is mild cognitive impairment (MCI-29), followed by depression (25), Alzheimer’s disease (AD-13), post-traumatic stress disorder (PTSD-10), and traumatic brain injury (TBI-8). (See table 2). Some key findings include risk reductions on financial risks, 67% at baseline and 75% on follow-up, completed advanced health directives increased from 69% to 85% at the last follow-up. Most were not driving despite their disability (86%) but this increased to almost all (95%) at follow-up. The knowledgeable about the disease increased from 56% to 84%. (See table 3). A full summary of results will be included on the poster.
Conclusions
Key lessons were learned on how to address barriers in identifying, screening, and assessing rural dwelling older Veterans, who frequently lack access to specialty services. This poster will detail the results from this collaborative demonstration project.