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

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. Goals of Presentation. • Highlight what some older veterans experienced during and after the war

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

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  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-to’s 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

  5. 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 society’s 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

  7. 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.)

  9. 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

  10. 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

  11. 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

  12. 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

  14. Aging Veterans They fought and suffered for this country and a significant minority have been fighting to reclaim their lives ever since Shouldn’t we help them get their lives back?

  15. Military Trauma in Older Veterans A silent problem A hidden influence. Don’t let it go unrecognized or untreated any longer.

  16. 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.

  18. 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

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