Vietnam Veterans Day on 18 August is an opportunity for health practitioners to focus on how they can support the mental health of the 60,000 Australians who were deployed to Vietnam.
On Vietnam Veterans Day we remember the service of the 60,000 Australians who served in Vietnam during 1962–1975. They are now in their 60s, 70s, and 80s, and for those caring for them it is helpful to understand general ageing issues as well as veteran mental health issues.
Older veterans may currently be experiencing extreme loneliness, anxiety, depression, worry, anger, and a sense of isolation because of the coronavirus pandemic. This is an added consideration for practitioners who have an important role to play in monitoring and supporting the mental wellbeing of their older clients. Older veterans in your care may require extra support at this time, so it is worth considering providing more frequent contact via telehealth or face-to-face or by connecting them into community or Open Arms group programs that provide them with additional social support.
Successful, healthy ageing is a lifelong process that can be enhanced at any age. By creating an environment and opportunities that enable people to do what they value, we can help veterans age successfully.
Ageing is a time of change
Ageing brings many life changes that need to be navigated, such as retirement, illness and the death of a partner or friends. It can also be a time of reflection: “Has my life been meaningful, and what contributions have I made?” The interaction between mental and physical health is particularly important at this time. Changes related to physical and cognitive agility and chronic diseases need to be monitored and managed.
People who are vulnerable to mental health difficulties can experience an increase in symptoms during times of change, or as they age.
Vietnam veterans and PTSD
Research indicates that Vietnam veterans have a higher rate of PTSD and comorbid disorders than more contemporary veterans. In addition, the risk of dementia increases not only with age, but also by the presence of PTSD, depressive disorder, or alcohol-related disorders.
The severity of PTSD can change over time and can be exacerbated by stress. Some symptoms such as nightmares and intrusive thoughts often decrease with age, but they can increase with triggers. For example, taking part in military-related activities such as commemorations, interviews, and social activities can be a positive, enjoyable and affirming experience for some veterans, but for others they can be symbolic reminders of traumatic events and hence distressing. Suicide risk, if present, does not decrease even when someone’s mobility or physical capacity declines.
A strengths-based approach to healthy ageing
A recent Australian study (Australian Research Study on Healthy Ageing) asked older veterans to describe what ageing well meant to them. They revealed that the areas of importance to them in older age included health, social wellbeing, and involvement in meaningful activities. They also described the use of positive coping strategies to adapt to chronic physical and mental health conditions.
I do have PTSD, severe mental problems … fitness is absolutely paramount for depression, and you could go for a walk or a run and if you’re in a depressed state you feel that at least I’ve achieved something for the day… I don’t drink, or very rarely. I keep very fit. And I find that I manage life that way.”
Another participant described his view of ageing well as having a positive attitude.
I never think now that I can’t do things … I’m about 42 miles an hour slower than when I was 50 or 40, but I still do it, I never think that I can’t.”
The good news is that while many older adults have one or more health conditions, if well controlled they have minimal influence on wellbeing. Recent studies suggest that the healthy aged, especially those who do not have cardiovascular disease, dementia or brain injuries, are less likely to show cognitive decline. And older veterans can continue to benefit from appropriate psychological therapy and from meaningful physical, intellectual, and social activities.
Practitioners who care for ageing veterans should focus on ensuring that meaningful activities are maintained. For many, but not all, this includes helpful and enjoyable social contacts, so helping veterans maintain or develop these further is important.
Simple ways for veterans to reduce stress and stay healthy
Simple, practical strategies can be effective in helping a veteran to reduce stress, restore a sense of control, and maintain health, particularly during a pandemic. Practitioners should encourage veteran patients to:
- stay connected with friends and family – technology is key at this time of social distancing; National Seniors Australia offers an online course to help seniors learn to use technology
- limit their exposure to media coverage, such as military events and coronavirus news updates
- look after themselves by eating well, getting regular exercise, making time for relaxation, and cutting back on coffee, cigarettes, drugs, and alcohol
- keep up their routines
- do something enjoyable every day
- seek professional support if they are finding it hard to cope.
A free, nation-wide service, funded by the Department of Veterans’ Affairs, is available to provide expert multidisciplinary support and guidance to health practitioners, support organisations and others working with Australian veterans with mental health problems. Contact the advice line on 1800 VET 777.
Specific care for ageing veterans
Veterans can access a range of resources designed specifically for their needs into older age.
Veterans’ Home Care
For older clients of the Department of Veterans’ Affairs (DVA) who need a small amount of practical help to continue living independently in their own home. It includes personal care, domestic assistance, and safety related maintenance. Assistance is also available to in-home carers through short-term respite care.
DVA Community Nursing Program
Home community nursing services is available to veterans to meet their assessed clinical and personal care needs. The aim is to enhance the person’s independence and health outcomes by avoiding early admission to hospital and/or residential care through access to community nursing services.
Veterans’ Medicines Advice and Therapeutics Education Services (Veterans’ MATES)
This service provides General Practitioners with information regarding medications dispensed to their veteran patients. Educational material is available for GPs and veterans focussed on increasing use of under-used medicines, reducing adverse drug events, reducing use of unnecessary medicines, and improving the utilisation of health services.