Approximately 50,000 veterans are receiving aged care services in Australia, a cohort that often has more complex needs than the rest of the population, and where specific training and awareness – and a clear focus on person-centred care – are vital.
Veterans are exposed to experiences and injuries that most people will never encounter, and consequently, they often have greater, more complex care needs.
Researchers from Bolton Clarke Research Institute (BCRI) have borne this out through studies, finding that veterans receiving home nursing services, and their dependents, have greater needs and require more support than non-veterans.
An analysis of nearly 12,000 episodes of home nursing care for almost 6,000 veterans showed they had longer consultations, greater hours of care and more home visits.
BCRI Research Fellow, Dr Marissa Dickins, said, “There are exposures that veterans experience that aren’t common in the rest of the population. Wartime service has particular exposures and injuries … and we also know that they can experience psychological trauma as part of serving in the military,” Dr Dickens told HelloCare.
“That can affect [the veteran’s] ability to cope as they age and may affect the kind of care they need.”
Veterans are at greater risk of developing post-traumatic stress disorder, heart attack, stroke, asthma, arthritis and diabetes than non-veterans.
BCRI research identified that approximately 20% of veterans are estimated to have met the criteria for PTSD in their lifetime, and just under 1 in 5 reached the criteria for PTSD within the past 12 months of the study.
Dr Dickins told HelloCare that PTSD, once known as ‘shell shock’, only recently began to be recognised as a condition.
Today, younger veterans may have a better understanding of PTSD, or what they are experiencing and why, but there is still limited awareness among older veterans.
“It’s not well recognised, particularly those in the older age group, because this is a fairly new concept,” Dr Dickins said.
Having PTSD doubles the risk of developing dementia, and veterans living with dementia may have “particularly complex needs,” said Dr Dickins.
Symptoms can include flashbacks, hyper-vigilance and hyper-reactivity, which can be misdiagnosed as behavioural or psychological symptoms of dementia.
The move into residential aged care is difficult for most people, but for veterans, it can be particularly challenging.
“The institutional-type environment, losing capacity and not being able to look after yourself is difficult to deal with for anyone, but if you do have those types of traumas, particularly if they involve some kind of incarceration, or been held against their will in a wartime setting, it can definitely be triggering if you shift into a residential care facility.”
Bolton Clarke has seen ageing veterans who have recovered from PTSD move into residential aged care, only to have their PTSD triggered once again.
The re-emergence of PTSD can be particularly difficult because the person may not recognise it, or disclose it to aged care staff. “Once carers recognise what the issues are, it’s more manageable,” Dr Dickins said.
Carers should always be aware if the person they are caring for is a veteran, and person-centred care is particularly important for this group.
Carers must understand the person, understand what might be a trigger for them, what their goals are, and what is important to them in terms of care, Dr Dickins said.
“This is particularly important when it comes to issues such as PTSD,” she said.
“Understanding what might be a trigger for them … is particularly important as we move into the higher levels of care for individuals who have had trauma in their past, particularly if they are living with dementia.”
Exercise therapy, reminiscence therapy, sensory modulation and music therapy can all generate improved outcomes, reducing responsive behaviours and improving capability and emotional state in veterans.
BCRI has developed a series of videos – The Veteran Family Mental Wellbeing Series – for current and former members of the Australian Defence Force and their families and friends.
BCRI has also developed ‘WEAVE’, a program that builds on the Veteran Family Mental Wellbeing Series to support the well-being of veterans living with dementia through the use of music therapy, sensory modulation, reminiscence therapy and exercise therapy.
Carers of veterans must also look after themselves, urged Dr Dickins.
BCRI research has found that carers and spouses report poorer health and psychological wellbeing than average, and are at greater risk than the general population of poor physical and mental health, chronic stress, institutionalisation and even early mortality.
Results are particularly concerning for carers living with and caring for veterans with PTSD.
“Looking after yourself is really important so you can continue to look after them,” Dr Dickins said.
