Most Veterans are receiving medical and mental health care in the community, which means most are not enrolled in the Veterans Administration (VA) Health Care System. When the VA and National Hospice and Palliative Care Organization partnered to create the We Honor Veterans program, 85% of Veterans receiving end of life care in hospice were not enrolled in the VA. Many chronic diseases, and co-morbidities were related to military service. Injuries which have never been evaluated while active duty may have continued to deteriorate, including TBI (Traumatic Brain Injury).
Therefore the question, “Are you a Veteran?”, must be included in all assessments and health history as part of demographics and questionnaires. The Veterans’ health history is related to their military service, whether they served four years or 24 years. The diseases and illness may be different, reflective and unique for the war era in which they served, but significant. The experience at the end of life is greatly affected by their military service, and the military culture of stoicism. Undiagnosed Post Traumatic Stress Disorder is a significant barrier to a peaceful death.
Ask the question.
Are you a Veteran? Have you ever served in the Military? Many older Veterans from WWII or the Cold War, who were not in combat, do not consider themselves Veterans. Ask how many times they have had head injuries, not if they have had a head injury. Head injuries and other physical injuries may have never been evaluated due to the stigma surrounding the need for intervention and time off.
Depression, substance abuse, and anxiety are the most common mental health concerns, and suicide. Many have undiagnosed Post Traumatic Stress Disorder, with the manifestation of symptoms upon retirement and increasing weakness with aging. The stoicism of the military culture begins to crumble with increasing weakness.
Grief is real.
Veterans have experienced tremendous loss. Traumatic Grief is the overwhelming sense of loss when multiple close comrades die at one time. Witnessing the horrific death of comrades, yet not allowing the time to grieve. As a result of injuries in combat, they may have lost a limb, hearing, or eyesight. As Veterans age, they experience the death of a spouse, a child, sibling, loss of good health.
The Veteran has returned from war not the same person, they have changed. There is the need to grieve the loss of the person they used to be. Unresolved traumatic grief may be manifested in anger and violence.
Bearing witness to stories of war does come with a cost.
Nurses, physicians, healthcare providers, ask the patient if he/she is a Veteran. Ask if they served in the military. Complete a Military Assessment, and offer support, honoring their service and sacrifice with gratitude. As civilians, share the burden of war by being fully present, holding a safe space for the sacred stories of war.