Military Trauma: A Hidden Influence in the Lives of Older Veterans

1
Military Trauma A Hidden Influence in the
Lives of Older Veterans

• Congressional Briefing
• June 21, 2004
• Joan M. Cook, Ph.D.
• University of Pennsylvania
• Philadelphia VA Medical Center

2
Goals of Presentation

• Highlight what some older veterans experienced
  during and after the war
• Discuss the potential negative effects of
  military trauma
• Describe unique characteristics of older
  veterans that need specific attention
• Suggest that we can learn from older veterans
  in terms of trauma-related distress and the
  how-tos of adaptation and resilience

3
Military Trauma Combat and Captivity

• Diagnostic Criteria for Traumatic Event
• Involve actual or threatened death or serious
  injury to self or others
• Firefights
• Seeing mutilated bodies, atrocities
• Death and dying
• Medical care in the field
• Being held captive
• Torture
• Include a response of intense fear,
  helplessness, or horror

4
PTSD has been recognized for over 100 years under
different labels

• Shell Shock
• Battle Fatigue
• War Neurosis
• Irritable Heart

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It was not until 1980 that PTSD was included in
the Diagnostic and Statistical Manual for Mental
Disorders Third Edition
6
Upon Returning, the Majority of the World War II
and Korean Conflict Veterans

• Responded to societys expectations to put it
  all behind them
• Believed that emotional problems related to the
  war were signs of character weakness
• Hid post-war trauma conflicts
• Espoused a John Wayne model and used avoidant
  and suppressive techniques rather than sharing
  memories and feelings

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Upon Returning, the Majority of the World War II
and Korean Conflict Veterans

• Felt unsafe and vulnerable
• Sensed that they were broken, damaged, or no
  longer oneself
• Believed they should have been able to prevent
  both the trauma and the difficulties that
  followed the trauma often resulting in guilt,
  shame and self-blame
• Experienced sadness over lost aspects of self
  such as innocence and trust in the goodness of
  humanity

8
Upon Returning, the Majority of the World War II
and Korean Conflict Veterans

• Experienced physical complaints (e.g., tension
  headaches or pains in the head, migraines, low
  back pain, ulcers or other stomach complaints,
  irritable colon, hypertension, etc.)

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Course of PTSD

• The only report of the course of PTSD in older
  adults is from a sample of ex-prisoners of war
• Symptoms wax and wane across the lifespan
• 20 continuously troubled
• 20 are symptom free
• 60 experience intermittent symptoms

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Symptoms of PTSD Likely Exacerbate with Age

• This may be due in part to life changes and
  losses.
• With advancing age, there is
• increased risk for medical illness
• decrements in functional status
• bereavement
• retirement
• changes in social and familial roles
• loss of control
• more time for reflection

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Importance of Provider Identification and
Understanding

• Trauma/PTSD May Underlie Other Problems
• High medical utilization
• Problems in living (e.g., social, marital,
  general
• functioning)
• Relationship with formal and informal care
• providers (e.g., difficulty trusting
  others
• increased irritability/anger)
• Adherence to treatment

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PTSD, if left untreated, often becomes a chronic
condition
13
War poses one of the single greatest threats to
the physical and mental health of individuals and
societies
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Aging Veterans

• They fought and suffered for this country
• and a significant minority have been
• fighting to reclaim their lives ever since
• Shouldnt we help them get their lives back?

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Military Trauma in Older Veterans

• A silent problem
• A hidden influence.
• Dont let it go unrecognized or
• untreated any longer.

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We now recognize that there are some immediate
tasks upon return of the veterans to facilitate
reintegration into everyday life in the community
17
There is a subgroup of veterans that are going to
need assistance in a long-term adjustment
process.Some face chronic problems, some face
recurrent ones and as they age it is important
that we not forget the sacrifice they made and
our continuing debt and responsibility to them.
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Policy Recommendations

• Support for research related to physical, mental,
  and behavioral health in veterans
• Support for translation of research findings into
  prevention and intervention services that assist
  veterans and their families
• Support services for veterans impacted by
  traumatic events