[NYAPRS Enews] HP: Older Veterans Also Have Mental Health Needs

Mon Nov 12 10:02:15 EST 2012

Older Veterans Also Have Mental Health Needs

by Michael Friedman, L.M.S.W. Adjunct Associate Professor, Columbia
University Schools of Social Work and Public Health  Huffington Post
November 12, 2012

"The war. It's what happened to me in the war. I could never get over
it. But I learned to live with it. Then all of a sudden on my 60th
birthday it became a terrible weight. I couldn't put it out of mind. I
feel so very depressed about it. Sometimes I sit for hours, brooding
over the past."

So begins Wilbur Cohen's account of his own suffering in Arthur
Kleinman's wonderful book What Really Matters. (1) Mr. Cohen had been in
hand-to-hand combat in the Pacific theatre in World War II. After the
war he had gone to college, become financially successful, and raised a
family. Only after he had fulfilled his responsibilities as an adult did
his profound sense of horror about the war return.

Mr. Cohen's experience is not unique. Old psychic wounds re-emerge for
many veterans as they age. But older veterans with mental health needs
have not received nearly as much attention as the men and women who have
been deployed in the wars in Iraq and Afghanistan.

This is entirely understandable. Veterans of our nation's current wars
often suffer terribly and deserve all the support that our nation can
muster. But the fact of the matter is that veterans of these recent wars
make up only 10-15 percent of our nation's veterans. Currently, more
than 50 percent of veterans are 60 or older, and about 45 percent are 65
or older. The Department of Veterans Affairs (VA) projects that these
proportions will continue at least until 2035. (2)

Unfortunately, like veterans of recent wars, older veterans are a higher
risk than the general population for mental disorders, including:

* Depression, the prevalence of which may be double that of older adults
who are not veterans. (3) 
* Post-traumatic stress disorder (PTSD), which can continue for years or
can re-occur in old age. (4) 
* Suicide. Older veterans appear to have a suicide rate 50 percent
greater than older adults who did not serve in the military. (5)

Those with PTSD are also at heightened risk for dementia. (6) Like all
people disabled by dementia, veterans rely heavily on family members for
care and support. And they, like all family caregivers, are at high risk
of social isolation, depression, and anxiety. (7)

In addition to being at risk for diagnosable mental disorders, older
veterans are risk for Late-Onset Stress Symptomatology (LOSS). According
to the National Center on PTSD, "Many older veterans have functioned
well since their military experience. Then later in life, they begin to
think more or become more emotional about their wartime experience. "
(8)

Treatment Works -- When Used

Treatment of depression and other affective disorders as well as of
anxiety disorders, including PTSD, is often effective for veterans as
for those without military experience. In addition, new models of
treatment are emerging for veterans. For example, Translating
Initiatives for Depression into Effective Solutions (TIDES) "has shown
impressive results with eight out of ten veterans effectively treated in
three VA regions." (9)

Unfortunately, a recent study of depression treatment of older adult
veterans concluded, "The odds of receiving depression treatment
decreased with increasing age ... Many depressed older [veterans] may
have limited or no treatment." (10)

VA Initiatives for Older Veterans

Over the past few years, the VA has significantly increased its efforts
to respond to the mental health needs of veterans, with particular
attention to those returning from Iraq and Afghanistan. Older veterans
have benefited from these efforts to prevent suicide, to increase
accessibility to treatment, to use evidence-based treatments, and to
build delivery systems that integrate physical and behavioral health
services.

In addition, the VA has undertaken several initiatives that are specific
to older veterans, especially the integration of mental health providers
on home-based primary care teams, in the VA's long-term care centers,
and in hospice and palliative care settings, spinal cord injury centers,
and rehabilitation centers for the blind. (11)

Promises to Keep: Criticism of VA Initiatives for Older Veterans

Despite the VA's substantially stepped up efforts to expand and improve
mental health care for older veterans, advocates for veterans such as
Vietnam Veterans of America and Veterans for Common Sense maintain that
the VA is not moving quickly enough. They note, for example, that the
VA's increase of services and staff has not kept pace with increasing
need (12) and a VA investigation revealed the VA does not consistently
live up to its policy requiring rapid evaluation and treatment planning
for veterans requesting mental health services. (13)

The VA Cannot Do It Alone

But the VA cannot do the whole job. Some 70 percent of veterans do not
use the VA for their health care. There are many reasons for this --
limited eligibility, not being in priority populations, distance to VA
centers, dissatisfaction with service in some facilities, etc.

But it's not just inadequate capacity and resources in the VA that keeps
many veterans away. Many have returned to civilian life, to work and
family, and they want to get their health care from local health and
mental health providers. Unfortunately, many of these providers are
simply not prepared to deal with the special issues that older veterans
bring to them. (14)

What Needs to Be Done

In addition to increasing the pace of expansion and improvement of the
VA's mental health services, efforts need to be made to insure that
older veterans as well as veterans of current wars benefit, including:

* Outreach to older veterans designed to overcome the stigma, which is a
barrier to the use of services that are available.
* Increased support and training for primary care and mental health
providers in the community regarding the culture and special needs of
older veterans.
* Enhanced support for family caregivers.

Most importantly we need to acknowledge, thank, and honor our older
veterans for their service and sacrifice and assure them that our nation
will stand by them throughout their lives.

Asley Milco, a student at Columbia University School of Social Work,
provided research assistance for this post.

Need help? In the U.S., call 1-800-273-8255 for the National Suicide
Prevention Lifeline <http://www.suicidepreventionlifeline.org/> .

References:

(1) Kleinman, A. "Chapter 2: Winthrop Cohen" in What Really Matters:
Living A Moral Life Amidst Uncertainty and Danger
<http://www.oup.com/us/catalog/general/subject/Anthropology/SocialCultur
al/?view=usa&ci=9780195331325> . Oxford University Press, 2006.

(2) National Center for Veterans Analysis and Statistics. "Veteran
Population Projections: FY 2000 to FY 2006."
<https://www.va.gov/vetdata/Veteran_Population.asp>  December 2010.

(3) VA's National Registry for Depression
<http://www.va.gov/health/NewsFeatures/20110624a.asp> 

(4) Durai, et al. "Exposure to Trauma and Posttraumatic Stress Disorder
Symptoms in Older Veterans..."
<http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2011.03407.x/abs
tract> .Journal of the American Geriatrics Society, June 2011.

(5) Wood, Matt. "Crunching The Numbers on the Rate of Suicide Among
Veterans
<http://sciencelife.uchospitals.edu/2012/04/27/crunching-the-numbers-on-
the-rate-of-suicide-among-veterans/> " in Science Life, April 27, 2012.

(6) Qureshi SU, et al. "Greater prevalence and incidence of dementia in
older veterans with posttraumatic stress disorder
<http://www.ncbi.nlm.nih.gov/pubmed/20863321> ." In Journal of the
American Geriatrics Society, September 2010.

(7) Bass, D. et al. "Negative Caregiving Effects Among Caregivers of
Veterans With Dementia <http://scholar.qsensei.com/content/1s9005> ".
American Journal of Geriatric Psychiatry, March 2012.

(8) VA. "Aging Veterans and Post-Traumatic Stress Symptoms"
<http://www.ptsd.va.gov/public/pages/ptsd-older-vets.asp> . Information
on Trauma and PTSD. 12/20/2011

(9) National Alliance on Mental Illness. "Depression and Veterans Fact
Sheet
<http://www.nami.org/Template.cfm?Section=Depression&Template=/ContentMa
nagement/ContentDisplay.cfm&ContentID=88939> ". October 2009.

(10) Burnett-Ziegler, et al. "Depression Treatment in Older Adult
Veterans
<http://journals.lww.com/ajgponline/Abstract/2012/03000/Depression_Treat
ment_in_Older_Adult_Veterans.5.aspx> ". American Journal of Geriatric
Psychiatry, March 2012.

(11) Karlin, B. and Zeiss, A. "Transforming The Mental Health Care of
Veterans in the Veterans Health Administration
<http://www.highbeam.com/doc/1P3-2262823451.html> " in Generations,
Summer 2010.

(12) Abramson, L. "VA Struggles To Provide Vets With Mental Health Care
<http://www.npr.org/2012/04/25/151319599/va-struggles-to-provide-vets-wi
th-mental-health-care> " National Public Radio. April 25, 2012.

(13) VA. "Veterans Health Administration: Review of Veterans Access to
Mental Health Services
<http://www.va.gov/oig/pubs/VAOIG-12-00900-168.pdf> " April 23, 2012.

(14) Karlin, B. and Zeiss, A. "Transforming The Mental Health Care of
Veterans in the Veterans Health Administration
<http://www.highbeam.com/doc/1P3-2262823451.html> " in Generations,
Summer 2010.

For more by Michael Friedman, L.M.S.W., click here
<http://www.huffingtonpost.com/michael-friedman-lmsw> .

http://www.huffingtonpost.com/michael-friedman-lmsw/veterans-mental-heal
th_b_2037857.html 

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