Veterans in Care Homes: An International Scoping Review to Inform UK Policy and Practice
In contrast to the mental and physical health needs of veterans, veterans’ social care needs remain relatively neglected by policymakers and researchers. The aim of this study is to inform UK veterans policy and practice by drawing together the expectedly limited international research base on veterans in care homes. An international scoping review of peer-reviewed and grey research literature was conducted, informed by Levac et al.’s (2010) six-stage process. Thirty-three papers were found to meet the inclusion/exclusion criteria. The papers’ contents typically fell into one or more of the following themes: social connection, care preferences and autonomy, and military-related physical and mental health needs. Very little (n = 1) UK-situated research was found, with the majority of retrieved papers (n = 24) being US-based, impeding transferability and relevancy of the findings to a UK context. Veterans’ social care needs were found to be a largely underexplored area of research, especially in the UK. There is a pressing need for UK veterans’ policymakers to redress existing imbalances in the focus of policy and research by raising the status and importance of the social care needs of UK veterans, as has been achieved on the mental and physical health fronts.
Abstract: Context: In response to the opioid crisis, federal guidelines were implemented, including the Veterans Health Administration's (VA) Opioid Safety Initiative in 2013. The impact of policies on patients near the end of life is unknown. Objective: Examine temporal trends in opioid prescribing, pain, and opioid overdoses among Veterans near the end of life. Methods: Retrospective, time series analysis of VA decedents between October 2009 and September 2018 whose next-of-kin participated in VA's Bereaved Family Survey (BFS). Using multivariate regression to adjust for sociodemographic and clinical covariates, we examined temporal trends in outpatient opioid prescribing, uncontrolled pain based on BFS report, and opioid overdose-related hospitalizations, in the last month of life, overall and by clinical diagnosis (cancer versus non-cancer). Results: Among 79,409 decedents, mean daily outpatient opioid dose in morphine milligram equivalents in the last month of life decreased from 4.6 mg in 2010 to 2.1 mg in 2018 (adjusted change -0.20 mg/year; P