Suicidal Behavior and Suicide in Older Veterans (VA CSR&D, I01 CX001119-05)

Suicidal risk profoundly impacts Veterans, their families, and society. In 2008, the VA mandated that health system facilities track completed suicides, as well as attempted and serious suicide ideation. The data are now available and, to start, the evidence shows that the majority of Veteran suicides (> 69%) are in older Veterans (i.e., 50 years or older). However, most national suicide prevention programs and research studies of risk and protective factors target younger military personnel and Veterans returning from combat. Thus, the proposed project will have high impact, because it will provide evidence for future psychiatric research and policy planning that will help to define national priorities for suicide prevention over the long term in Veterans at greatest risk and in great need of care.

Precursors of Suicide in Older Adults Transitioning from Prison to Community (NIH/NIMH, I01 RF1 (R01) MH117604)

Many persons who die by suicide access health care services in the year before the death, indicating potential opportunity for improved detection and intervention in health care settings. This proposal focuses on determining precursors and health care services use patterns, and moderators of these patterns, following release from prison and transition into community living - a circumstance associated with exceptionally high rates of suicide and death by unintentional injury, including drug overdose. We propose an innovative method of linking administrative health care use datasets from Medicare and the VA (2008 – current available data) to identify a “prison release” cohort whose health care utilization (and that of a control cohort matched on age, sex, race, residential zip code, and Medicare status) can be tracked and compared over time. Findings from the proposed research can support suicide prevention efforts by informing prison-to-community transition care planning, with implications for multiple stakeholders. 

Alzheimer’s Disease and Related Dementias in The Most Incarcerated Generation: An Understudied Population with Health Disparities (NIH/NIA, R01 AG082157)

The proposed project is the first longitudinal and epidemiological examination of justice-involvement and dementia. Americans who experience justice-involvement, moving from the community to incarceration and from incarceration back to the community, are aging rapidly. Moreover, justice-involvement disproportionately impacts persons of color and of low socioeconomic status, who are also at high risk for all forms of dementia yet are frequently excluded from dementia-related research. This study will contribute to our understanding of health disparities in dementia by evaluating the inter-relationship among incarceration, dementia, and a number of important social risk factors and multi-morbidity factors over time in a national sample. Access to VA and Medicare data provides more complete outcome ascertainment, thus increasing the opportunity to determine if these profiles differ according to dementia subtypes (e.g., Alzheimer’s Disease, vascular, frontotemporal, mild cognitive impairment). This will inform strategies to mitigate risk of patients with dementia entering incarceration, will delineate those at highest risk of developing dementia after incarceration so as to inform prison-to-community transitional care planning, and will identify prime intervention points where optimizing dementia care could reduce health disparities between those with and without justice-involvement and even within the justice-involved.

Long-Term Neuropsychiatric Sequelae of SARS-CoV-2 Infection in Late Life (NIH/NIA, R01 AG076819)

The psychological and social impact of the pandemic have been severe and likely will have significant mental effects over the long term. There is also emerging evidence that suggests that COVID-19 may have direct effects on the brain or trigger immune responses that have additional adverse consequences on brain function and mental health in patients with COVID-19. COVID-19 has disproportionately impacted older adults, with those 65 years and older at heightened risk of severe illness. In fact, most older adults with COVID-19 survive initial infection and enter a clinical recovery phase for months or longer, which is often marked by persistent symptoms and adverse health outcomes. The primary goal of the proposed research is to determine whether COVID-19 is associated with increased incidence of dementia and new or reemergence of psychiatric disorders in a national sample of patients 65 years and older, with complete outcome ascertainment from Veterans Health Administration and Medicare data. The secondary aim is to examine risk factors associated with development of these neuropsychiatric disorders (i.e., dementia, mood disorders, anxiety disorders, and psychosis) among older adults with history of COVID-19.