Comorbidities, healthcare use, and contact with healthcare transition services in older veterans after incarceration.

BACKGROUND: The Health Care for Reentry Veterans (HCRV) program was established to support community reintegration for veterans after incarceration. Yet, it is unclear how those with and without HCRV contact differ. We sought to evaluate differences in medical and psychiatric conditions and healthcare utilization among mid-to late-life reentry veterans who did and did not receive HCRV outreach. METHODS: Study participants were veterans aged ≥50 years who qualified for Medicare fee-for-service, had experienced incarceration for ≥1 year, and were released from incarceration between October 1, 2006, and September 30, 2018 (N = 9733). Using VA and Medicare claims data, we compared prevalence of medical and psychiatric diagnoses, and use of emergency, inpatient, and outpatient medical and mental health services up to 12 months after release between those with and without HCRV contact. RESULTS: Veterans with HCRV contact (35.5%) had significantly higher rates of psychiatric conditions and medical conditions related to substance use (e.g., liver disease) compared to veterans without HCRV contact. Average time between release and first healthcare service use was significantly lower for HCRV veterans (36.5 ± SD 59.5 days) versus non-HCRV veterans (58.9 ± SD 77.5 days) and HCRV veterans were more likely to utilize the emergency department, inpatient and outpatient mental health services, and inpatient medical services. CONCLUSION: HCRV reaches older reentry veterans with a large burden of mental health and substance use disorders. However, levels of multimorbidity were high among all older reentry veterans, pointing to a need to develop specialized geriatric models of care for this reentry population.

High Risk of Substance Use Disorder-Related Outcomes in Veterans Released from Correctional Facilities in Mid to Late Life.

BACKGROUND: Veterans Affairs (VA) is likely to encounter a growing number of veterans returning to the community in mid to late life following incarceration (i.e., experiencing reentry). Yet, rates of negative health outcomes due to substance use disorders (SUDs) in this population are unknown. OBJECTIVE: To determine risk of and risk factors for SUD-related emergency department visits and inpatient hospitalizations (ED/IPH) and overdose death among older reentry veterans compared with never-incarcerated veterans. DESIGN: Retrospective cohort study using national VA and Medicare healthcare systems data. PARTICIPANTS: Veterans age ≥50, incarcerated for ≤5 consecutive years, and released between October 1, 2010, and September 30, 2017 (N = 18,803), were propensity score-matched 1:5 with never-incarcerated veterans (N = 94,015) on demographic characteristics, reason for Medicare eligibility, and SUD history. MAIN MEASURES: SUD-related ED/IPH (overall and substance-specific) were obtained from in-/outpatient VA health services and CMS data within the year following release date/index date (through September 30, 2018). Overdose death within 1 year was identified using the National Mortality Data Repository. Fine-Gray proportional hazards regression compared risk of SUD-related ED/IPH and overdose death between the two groups. RESULTS: The number of SUD-related ED/IPHs and overdose deaths was 2470 (13.1%) and 72 (0.38%) in the reentry sample versus 4402 (4.7%) and 198 (0.21%) in the never-incarcerated sample, respectively. Mid-to-late-life reentry was associated with higher risk of any SUD-related ED/IPH (13,136.2 vs. 2252.8 per 100,000/year; adjusted hazard ratio [AHR] = 2.19; 95% confidence interval [CI] = 2.08, 2.30) and overdose death (382.9 vs. 210.6 per 100,000/year; AHR = 2.24, 95% CI = 1.63, 3.08). CONCLUSIONS: Older reentry veterans have more than double the risk of experiencing SUD-related ED/IPH (overall and substance-specific) and overdose death, even after accounting for SUD history and other likely confounders. These findings highlight the vulnerability of this population. Improved knowledge regarding SUD-related negative health outcomes may help to tailor VA reentry programming.

Association of spouse's health status with the onset of depressive symptoms in partner: Evidence from the China Health and Retirement Longitudinal Study.

BACKGROUND: This study aimed to evaluate the associations between the multidimensional health status of one spouse and the onset of depressive symptoms in partner, and whether the associations differed by gender and residence. METHODS: We analyzed data from 2401 females and their husbands (scenario 1), and 2830 males and their wives (scenario 2) who participated in the 2011/2012 and 2015 waves of China Health and Retirement Longitudinal Study. Depressive symptoms were assessed using the 10-item Centre for Epidemiological Studies Depression Scale. Multidimensional health indicators included mobility disability, activities of daily living disability, frailty, global cognition, depressive symptoms, comorbidity, and self-reported health. Principal component analysis was used to construct a composite health indicator reflecting overall health status that was then categorized into three groups (poor, moderate, and excellent). Logistic regression models were performed. RESULTS: We observed strong associations of spouse's health status with the onset of depressive symptoms in partner. For instance, females whose husbands had poor overall health status reported more depressive symptoms than those having husbands with excellent overall health after four years (OR: 1.75; 95 % CI: 1.35, 2.26). These associations were statistically significant in rural females and urban males, but surprisingly disappeared in rural males and urban females. LIMITATIONS: No exact timing of depressive symptoms onset. CONCLUSIONS: In Chinese middle-aged and older adults, spouse's health status is associated with depressive symptoms in partner and the associations vary by gender and residence. The findings underscore the importance of considering partner's health status to manage one spouse's mental health.

Prevalence of dementia and mild cognitive impairment before incarceration.

BACKGROUND: Accumulating evidence indicates that behaviors in Alzheimer's disease and related dementias could result in incarceration. Yet, the proportion of persons diagnosed with dementia and mild cognitive impairment (MCI) before they were incarcerated is largely unknown. By leveraging a national sample of mid- to late-life adults who were incarcerated, we determined the prevalence of dementia and MCI before their incarceration. METHODS: In this current study, participants were Medicare-eligible U.S. veterans who transitioned from incarceration to the community in mid- to late-life from October 1, 2012, to September 30, 2018, after having been incarcerated for ≤10 consecutive years (N = 17,962). Medical claims data were used to determine clinical diagnoses of dementia and MCI up to three years before incarceration. Demographics, comorbidities, and duration of incarceration among those with dementia and MCI were compared to those with neither diagnosis. RESULTS: Participants were >97% male, 65% non-Hispanic white, 30% non-Hispanic black, and 3.3% had a diagnosis of either dementia (2.5%) or MCI (0.8%) before their most recent incarceration. Individuals with MCI or dementia diagnoses were older, were more likely to be non-Hispanic white, had more medical and psychiatric comorbidities, and experienced homelessness and traumatic brain injury at higher rates than those with neither diagnosis. Average duration of incarceration was significantly shorter among those with MCI (201.8 [±248.0] days) or dementia (312.8 [±548.3] days), as compared to those with neither diagnosis (497.0 [±692.7] days) (p < 0.001). CONCLUSIONS: These findings raise awareness of the proportion of incarcerated persons in the United States who have a diagnosis of MCI or dementia before they are incarcerated. Improved understanding of pathways linking cognitive impairment to incarceration in mid- to late-life are needed to inform appropriateness of incarceration, optimization of health care, and prevention of interpersonal harm in this medically vulnerable population.

Mental and Physical Health of Older Incarcerated Persons Who Have Aged in Place in Prison.

This study describes physical and mental health of incarcerated males aged ≥50 years who spent at least 20 consecutive years in prison, comparing those with life sentences ("lifers") with those expected to be released/paroled. Data included demographics, chronic medical conditions, self-reported and objective disabilities, depressive symptoms, suicidal ideation (SI), and social support. The 65 participants (Mage = 56.9, SD = 6.6) were racially diverse (40% White, 51% Black, 9% Hispanic/Other), incarcerated for M = 26.6 (SD = 4.5) years, and 34 (52%) were lifers. Among the 39 (60%) of participants with visitors, lifers had lower social support scores (p = .005). After controlling for age, race, and chronic conditions, lifers reported disability in a higher number of activities (p < .001), and had higher depressive symptoms (p = .08) and SI scores (p = .04). Health-related differences between lifers and those expected to be released have implications for prison systems including staff training, advance care planning, and need for expanding prison-based hospice programs.

Older incarcerated persons' mental health before and during the COVID-19 pandemic.

PURPOSE: Older incarcerated persons are an especially vulnerable segment of the prison population, with high rates of multimorbidity. This study aims to determine the impact of the COVID-19 pandemic on older incarcerated persons' mental and physical health. DESIGN/METHODOLOGY/APPROACH: Participants were 157 currently-incarcerated persons age ≥50 years who were enrolled in an ongoing longitudinal study before the pandemic. Anxiety symptoms (seven-item generalized anxiety disorder questionnaire), depressive symptoms (eight-item patient health questionnaire) and self-rated health (SRH) were assessed during in-person interviews completed before the pandemic and via mailed surveys during the pandemic (August-September 2020). A mediation model evaluated the relationship among anxiety, depression and SRH. FINDINGS: Participants were 96% male, racially diverse (41% White, 41% Black, 18% Hispanic/Other), with average age 56.0(±5.8) years. From before to during the pandemic, anxiety symptoms increased (worsened) (from 6.4 ± 5.7 to 7.8 ± 6.6; p < 0.001), depressive symptoms increased (worsened) (from 5.5 ± 6.0 to 8.1 ± 6.5; p < 0.001) and SRH decreased (worsened) (from 3.0 ± 0.2 to 2.6 ± 0.2; p < 0.001). The total effect of worsening anxiety symptoms on worsening SRH (-0.043; p < 0.001) occurs entirely because of worsening depressive symptoms, i.e. the direct effect was statistically non-significant -0.030 (p = 0.068). PRACTICAL IMPLICATIONS: Older incarcerated persons experienced worsening mental health during the COVID-19 pandemic which was associated with worsening SRH. These findings have implications for health-care costs and services needed to care for this vulnerable group. ORIGINALITY/VALUE: This is the first study to evaluate change in older incarcerated persons' mental health from before the COVID-19 pandemic to during the pandemic.

Cognitive Impairment in Older Incarcerated Males: Education and Race Considerations.

OBJECTIVE: Assess cognitive impairment (global cognition and executive functioning) in older incarcerated males overall, and according to education and race. DESIGN: Cross-sectional PARTICIPANTS: The sample included 239 racially diverse (37.7% White, 41.4% Black, 20.9% Hispanic/Other) incarcerated males age ≥50 (mean age = 56.4 ± 6.1; range 50-79 years). MEASUREMENTS: Global cognitive impairment assessed using the Montreal Cognitive Assessment (MoCA) - standard MoCA scoring (1-point adjustment for ≤12 years education, and score <26 indicating cognitive impairment) versus education- and race-specific cutpoints. Trail Making Test (TMT) assessed executive functioning. The relationship between race and cognitive impairment was evaluated using Chi-Square, One-Way ANOVA, and Tukey's HSD post-hoc analyses. Chi-Square was also used to evaluate the relationship between race and frequency of missed MoCA items. RESULTS: Average MoCA score was 24.12 ± 3.38. Overall, 62.8% and 38.5% of participants met criteria for cognitive impairment using standard scoring and education- and race-specific cutpoints, respectively. This difference was largely attributed to the change in proportion of Blacks who met criteria for cognitive impairment after applying education- and race-specific cutpoints (62.6% versus 19.2%). Fewer White inmates were impaired (51.1% versus 36.7%) after applying demographically-adjusted norms; however, the proportion of Hispanics/Others remained largely unchanged (84% versus 80%). A considerable proportion of participants were mildly impaired on TMT-A (18.2% Whites, 7.1% Blacks) and TMT-B (20.5% Whites, 4.1% Blacks). Race differences were observed in missed MoCA items. CONCLUSIONS: Cognitive impairment is common in older incarcerated persons, despite applying education- and race-specific norms. Notable race differences highlight need for validated assessments for this diverse population.

Association between early life circumstances and depressive symptoms among Chinese older adults: Results from China health and retirement longitudinal study: Early life circumstances and depression.

BACKGROUND: A growing body of literature suggests that early life circumstances can influence mental health throughout the lifespan. However, how these early life circumstances cumulatively contribute to depression in old age is not completely understood. The aim of this study was to examine the associations of eight factors with depression among community-dwelling older adults. METHODS: Data were from the China Health and Retirement Longitudinal Study. We included 8,239 community-dwelling individuals who were ≥60 years, completed the life history questionnaire, and had assessment of depression. An early life disadvantage index was established using risk factors that were significantly associated with depression. Logistic regression was used to examine the association of each early life risk factor and the index with depression. RESULTS: Of 8239 individuals included, 2,055 (24.9%) had depression. In bivariate analysis, each of eight early life risk factors was significantly associated with depression. Except for maternal and paternal education, all risk factors persisted to be associated with depression after multivariable adjustment. In the multivariable-adjusted model, a one-point higher in the early life disadvantage index (range: 0-6) was associated with a 45% (95% CI: 37%, 53%) higher odds of depression. LIMITATIONS: Depressive symptoms were measured in our study only by the CES-D scale. Some early life experiences might not be fully reliable due to recall bias. CONCLUSION: There was a strong association between early life environments and depressive symptoms among Chinese community-dwelling older adults. Adverse early life circumstances could contribute cumulatively to depression in old age.

Self-rated health and mental health among older incarcerated males.

OBJECTIVES: Older incarcerated persons are a rapidly growing population with considerable mental health needs. We evaluated perceived worth and meaningfulness in life as mediators in the relationship between self-rated health (SRH) and depression and anxiety. METHOD: Mediation analyses were conducted among 222 older incarcerated males from eight correctional facilities in Connecticut.PHQ-9 and GAD-7 assessed depression and anxiety, respectively. Subscales of the Geriatric Suicidal Ideation Scale (GSIS) measured perceived worth and meaningfulness in life. RESULTS: Greater SRH was associated with lower depression and anxiety. More perceived worth and meaningfulness in life were associated with better SRH and lower depression and anxiety. There is evidence of perceived worth and meaningfulness in life mediating the SRH-depression (ß = -0.86; 95% CI = -1.32 to -0.48; ß= -0.46, 95% CI = -0.82 to -0.17, respectively) and SRH-anxiety (ß = -0.71; 95% CI = -1.08 to -0.39; ß = -0.34, 95% CI = -0.65 to -0.10) relationships. CONCLUSION: SRH has both direct and indirect effects on depression and anxiety, by working through perceived worth and meaningfulness in life, in older incarcerated males. Assessing SRH, and focusing on ways to maintain self-worth and meaning, may be instrumental in promoting and sustaining their good mental health.

Functional disability, depression, and suicidal ideation in older prisoners.

BACKGROUND: The population of older prisoners (age ≥50), a group with high suicide rates, is growing. We sought to explore the associations among functional disability, depression, and suicidal ideation (SI) among older prisoners, focusing on the mediating role of depression. METHODS: Study participants were 220 sentenced male inmates age ≥50 who were incarcerated in 8 prisons. Face-to-face interviews were conducted following consent. Functional disability was assessed objectively, using the Short Physical Performance Battery (SPPB), and via self-report by asking participants their level of difficulty climbing stairs and completing activities necessary for daily living in prison (PADLS) such as standing in line for medications. The PHQ-9 and the Geriatric Suicide Ideation Scale assessed depressive symptoms and SI, respectively. Data were analyzed using linear regression models and causal mediation models. RESULTS: Participants were racially diverse and ranged from age 50 to 79 years. Whereas each functional disability measure was significantly associated with depressive symptoms, difficulty climbing stairs and PADL disability, but not SPPB score, were independently associated with SI. Depressive symptoms mediated the relationship between functional disability, assessed both objectively and via self-report, and SI. LIMITATIONS: Cross-sectional study design; possible under-sampling of participants with depressive symptoms and SI. CONCLUSIONS: Our findings have implications for suicide prevention in older prisoners. As this population continues to grow, prevention efforts should target those with depression, including but not limited to those with functional disability. Furthermore, assessing functional disability may offer a means of identifying those who should be screened for depression and suicidal ideation.

Interaction Between Vitamin D and Interleukin 6 on Slow Gait Speed: 6-Year Follow-up Data of Older Adults From InCHIANTI.

BACKGROUND: Whereas the independent effects of biomarkers, including 25-hydroxy vitamin D (25(OH)D), insulin-like growth factor 1, C-reactive protein, and interleukin 6 (IL-6), on gait speed in older adults have been evaluated, their joint effects on gait speed are not well understood. METHODS: Study subjects aged at least 65 at baseline (N = 970) were enrolled in the population-based Invecchiare in Chianti (InCHIANTI) study from 1998 to 2000 and were followed up at 3 and 6 years. All above biomarkers and gait speed data were measured at each of the three time points. Using a generalized estimating equation approach, we determined if slow gait speed (<0.8 m/s) was associated with the biomarkers. Further investigation was conducted for interactions between high IL-6 (≥.87 pg/mL) and other biomarkers focusing on low 25(OH)D (<20 ng/mL). RESULTS: After controlling for other biomarkers and potential confounders, IL-6 emerged as the only biomarker independently associated with gait speed. The association between high IL-6 and slow gait speed was enhanced by low 25(OH)D, with significant interaction between high IL-6 and low 25(OH)D (p = .038). The odds ratio of slow gait speed for low 25(OH)D and high IL-6 was 1.63 (95% confidence interval [CI]: 1.15, 2.32) compared with the reference groups with both biomarker levels at the other ends. CONCLUSION: The association of low vitamin D with slow gait speed statistically interacts with high IL-6. Coexisting vitamin D insufficiency and inflammation may provide a better biomarker for identifying those at risk of developing impairments in gait speed than either factor alone.

Associations of Hearing Loss and Depressive Symptoms With Incident Disability in Older Adults: Health, Aging, and Body Composition Study.

BACKGROUND: Depressive symptoms and hearing loss (HL) are independently associated with increased risk of incident disability; whether the increased risk is additive is unclear. METHODS: Cox Proportional Hazards models were used to assess joint associations of HL (normal, mild, moderate/severe) and late-life depressive symptoms (defined by a score of ≥8 on the 10-item Center for Epidemiologic Studies-Depression scale) with onset of mobility disability (a lot of difficulty or inability to walk » mile and/or climb 10 steps) and any disability in activities of daily living (ADL), among 2,196 participants of the Health, Aging and Body Composition Study, a cohort of well-functioning older adults aged 70-79 years. Models were adjusted for age, race, sex, education, diabetes, hypertension, and body mass index. RESULTS: Relative to participants with normal hearing and without depressive symptoms, participants without depressive symptoms who had mild or moderate/severe HL had increased risk of incident mobility and ADL disability (hazard ratio [HR] for mobility disability, mild HL:1.34, 95% confidence interval [CI]: 1.09, 1.64 and HR for mobility disability, moderate/severe HL: 1.37, 95% CI: 1.08, 1.75 and HR for ADL disability, mild HL: 1.32, 95% CI: 1.08, 1.63, and HR for ADL disability, moderate/severe HL: 1.42, 95% CI: 1.11, 1.82). Among participants with depressive symptoms, mild HL (HR: 1.71, 95% CI: 1.09, 2.70) was associated with increased risk of incident mobility disability. CONCLUSIONS: Independent of depressive symptoms, risk of incident disability was greater in older adults with HL, regardless of severity. Further research into HL interventions may delay disability onset.

Health-care needs of older women prisoners: Perspectives of the health-care workers who care for them.

The proportion of older incarcerated women is growing, yet little is known regarding their health-care needs. Using focus group methodology, this study sought to elucidate the unique health-care needs of older women prisoners through the perspectives of correctional health-care providers. Three organizing themes emerged regarding the health of older women prisoners: (a) the meaning of being "older" in the prison setting; (b) challenges impacting correctional health-care workers' care delivery; and (c) unmet health-care-related needs. Correctional health-care workers' insights can provide guidance regarding how to optimize the health of the increasing population of older women prisoners.

Associations of Adverse Childhood Experiences with Past-Year DSM-5 Psychiatric and Substance Use Disorders in Older Adults.

OBJECTIVES: To examine the prevalence of adverse childhood experiences (ACEs) and the associations of ACEs with psychiatric and substance use disorders among older adults in the United States. DESIGN: Cross-sectional analysis of the 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions Wave III (NESARC-III). SETTING: Nationally representative drug-related health interview survey in the United States. PARTICIPANTS: Survey respondents aged 65 or older (n = 5806 unweighted). MEASUREMENTS: ACEs, the key independent variable, were assessed using validated measures. Outcome variables consisted of past-year psychiatric disorders (eg, major depressive disorder and generalized anxiety disorder) and substance use disorders (eg, alcohol use disorder) using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. We estimated the national prevalence of ACEs in older adults and used multivariable-adjusted logistic regression analyses to assess the association between ACEs and the outcomes after adjusting for sociodemographics and clinical comorbidities. RESULTS: Overall, 35.9% of older adults, representative of 14.8 million older adults nationwide, reported some form of ACEs. The most common types were parental psychopathology (20.3%), other traumatic events (14.0%), and physical/psychological abuse (8.4%). Having experienced any ACEs was associated with higher odds of having a past-year psychiatric disorder (adjusted odds ratio = 2.11; 95% confidence interval = 1.74-2.56). Similar results were found for substance use disorders (P < .01). CONCLUSION: ACEs are linked to an increased risk for past-year psychiatric and substance use disorders in older adults. ACEs may have long-term effects on older adults' mental well-being. Although further research is needed, preventing ACEs may lead to large improvements in public mental health that persist well into older age. J Am Geriatr Soc 67:2085-2093, 2019.

Mental health treatment among older adults with mental illness on parole or probation.

BACKGROUND: The number of older adults on parole and probation is growing at an unprecedented rate, yet little is known about the mental health needs and treatment utilization patterns among this group. The objective of this study is to compare the prevalence of serious or moderate mental illness (SMMI), and the proportion of those with SMMI who receive mental health treatment, among community-dwelling older adults on correctional supervision (parole or probation) vs. not on correctional supervision. METHODS: Design: Cross-sectional analysis of data from the 2008-2014 National Surveys for Drug Use and Health (NSDUH). SETTING: Population-based national survey data. PARTICIPANTS: Older adults (age ≥ 50) who participated in the NSDUH between 2008 and 2014 (n = 44,624). Participants were categorized according to whether they were on parole or probation during the 12 months prior to survey completion (n = 379) vs. not (n = 44,245). MEASUREMENTS: Probable SMMI was defined using a validated measure in the NSDUH. Mental health treatment included any outpatient mental health services or prescriptions over the 12 months prior to survey completion. We compared the prevalence of SMMI, and the proportion of those with SMMI who received any treatment, by correctional status. RESULTS: Overall, 7% (N = 3266) of participants had SMMI; the prevalence was disproportionately higher among those on parole or probation (21% vs. 7%, p <  0.001). Sixty-two percent of those with SMMI received any mental health treatment, including 81% of those on parole or probation and 61% of those who were not (p <  0.001). This result remained statistically significant after logistic regression accounted for differences in sociodemographics and health. CONCLUSIONS: SMMI is disproportionally prevalent among older adults on parole or probation, and community correctional supervision programs may be facilitating linkages to needed community-based mental health treatment.

The Relationship Between Emotional Support and Health-Related Self-Efficacy in Older Prisoners.

Objective: To determine whether emotional support, and proportion of emotional support provided by specific sources (e.g., family, other prisoners, clinicians), is associated with health-related self-efficacy among older prisoners. Method: Cross-sectional study of 140 older prisoners age ≥50 with chronic medical illness who completed face-to-face interviews. Logistic regression, controlling for demographic, incarceration, and clinical/behavioral factors evaluated the association between emotional support, operationalized as a score and as a proportion of total emotional support from specific sources, and health-related self-efficacy. Results: Higher emotional support scores, and greater proportion of support from clinicians, were associated with lower likelihood of poor health-related self-efficacy. Those with >50% of their emotional support coming from other prisoners had higher likelihood of poor self-efficacy. Discussion: Among older prisoners with chronic illness, higher emotional support, particularly from clinicians, is associated with lower likelihood of poor self-efficacy; relying on other prisoners for emotional support is associated with poor health-related self-efficacy.

Increased Risk of Suicide Attempts and Unintended Death Among Those Transitioning From Prison to Community in Later Life.

OBJECTIVE: The number of individuals transitioning from correctional facilities to community in later life (age ≥50 ) is increasing. We sought to determine if later-life prison release is a risk factor for suicidal behavior and death by accidental injury, including drug overdose. DESIGN: Retrospective cohort study. SETTING: U.S. Department of Veterans Affairs and Medicare healthcare systems, 2012-2014. PARTICIPANTS: Veterans age ≥50 released from correctional facilities (N = 7,671 re-entry veterans) and those never incarcerated (N = 7,671). METHODS: Dates of suicide attempt and cause-specific mortality defined using the National Suicide Prevention Applications Network and the National Suicide Data Repository, respectively. RESULTS: Later-life prison release was associated with increased risk of suicide attempt (599.7 versus 134.7 per 100,000 per year; adjusted hazard ratio [HR] 3.45; 95% confidence interval [CI] 2.24-5.32; p < 0.001, Wald χ2 = 31.58, degrees of freedom [df] = 1), death by drug overdose (121.7 versus 43.5; adjusted HR 3.45; 95% CI 1.37-8.73; p = 0.009, Wald χ2 = 6.86, df = 1), and other accidental injury (126.0 versus 39.1; adjusted HR 3.13; 95% CI 1.28-7.69; p = 0.013, Wald χ2 = 6.25, df = 1), adjusting for homelessness, traumatic brain injury, medical and psychiatric conditions, and accounting for competing risk of other deaths. Suicide mortality rates were observed as nonsignificant between re-entry veterans and those never incarcerated (30.4 versus 17.4, respectively; adjusted HR 2.40; 95% CI 0.51-11.24; p = 0.266, Wald χ2 = 1.23, df = 1). CONCLUSION: Older re-entry veterans are at considerable risk of attempting suicide and dying by drug overdose or other accidental injury. This study highlights importance of prevention and intervention efforts targeting later-life prison-to-community care transitions.