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A vast majority of older veterans (93%) report exposure to at least one potentially traumatic event during their lifetime1. Some develop posttraumatic stress disorder (PTSD); however, most do not, as the prevalence of PTSD in later adulthood is low2. Around 10% of older veterans experience PTSD later in life1. PTSD is a mental health condition that can occur in the aftermath of experiencing or witnessing a traumatic event and includes symptoms that fall into four clusters: intrusive memories, avoidance of reminders, negative alterations in cognition and mood, and alterations in arousal and reactivity3.
Although PTSD in later life is less common, many veterans report thinking more about their military experiences as they age. While some may be familiar with PTSD as a result of combat, natural disasters, or other traumatic events, many of us are less familiar with the ways PTSD can resurface, or emerge for the first time, as we age. It can start when older veterans have experiences common in aging, such as illness, hospitalizations, declining health, retirement, or bereavement. Older veterans are sometimes reminded of traumas they previously considered 'resolved,’ successfully avoided thinking about, or had not previously bothered them. This process is called Later-Adulthood Trauma Reengagement4 (LATR, pronounced later). A desire to face and resolve memories of traumatic experiences may be stronger later in life as individuals engage in life review4. Military veterans in particular may be driven to resolve feelings related to the impact of military service in their lives4,5.
In the face of traumatic events, many veterans demonstrate psychological resilience, the ability to cope with the traumatic experience through personal strengths and use of effective coping skills. These skills allow them to protect themselves from the potential negative effects of trauma. A majority of older veterans who have experienced traumatic events also demonstrate incredible resilience; resilience in older veterans is associated with enhanced social connectedness, community integration, and purpose in life6.
As part of an ongoing educational project funded by the U.S. Department of Veterans Affairs (VA) Office of Rural Health, our group has been developing an educational resource library to serve rural veterans, who may have less access to meeting with specialty-trained clinicians for care, and for other veterans to normalize late-life PTSD. Based on an educational needs assessment using focus groups with community hospice and palliative care as well as VA home-based primary care clinicians, we learned about the complexities of supporting veterans with late-life PTSD and advanced illness.
Out of these focus groups, we developed our podcast Talking Later. Each episode begins with a real veteran’s story, told in the veteran’s own words. Stories were gathered using the My Life, My Story approach7, with additional questions that asked specifically about the occurrence of increased trauma or military-related memories in later life. Following the veteran’s story, the podcast’s co-hosts, VA clinicians and researchers, discuss what the veteran’s story can teach us about PTSD, LATR, and resilience. Our goals for the podcast are to provide education about late life PTSD to veterans, families, and clinicians, and to help older veterans feel less alone, gain an understanding of their experiences, and encourage treatment.
The podcast took one year to develop from start to release. With post-production support from VA Employee Education Services, the podcast was then posted for accessibility by numerous podcast platforms. We disseminated information about the podcast through newsletters, online announcements, and emails. Since release we have systematically evaluated the podcast, considering usage counts and surveys with clinician listeners. In the first three months (11.25.21 to 02.28.22), the podcast has had 1,473 total plays. In surveys, health care professionals (N=39) rate the podcast as engaging and informational. A majority (94.8%) found the veteran’s story to be engaging; 97.5% found the host discussion engaging, and 97.5% found the host discussion informational.
Recent highlights of Veteran stories from the podcast:
“I wear a baseball hat that identifies me as a Veteran. I didn’t start wearing that until the past few years. I spent a long time hiding my service. I don’t wanna do that anymore”
“I feel proud of serving my country, but I saw terrible things and I lived with that for years.”
“I still have bad times about that time period.”
“I loved the military but some of my experiences have left me with PTSD.”
“I remember saying, if I don’t die in Vietnam, I’m going to live to be 150.”
“I hadn’t realized the extent to which my PTSD had impacted my relationships. I had alienated my friends, my children, and my family.”
“I cope with memories by calling my psychologist…And we talk about it.”
“Where the VA has been the best for me is that it helped me understand the impact of PTSD on my life.”
Tune in to hear veterans share their ups and downs, and ways that they coped with what they have gone through. You can find Talking Later on your favorite podcast app on your smartphone by searching Talking Later, or on your computer, VA iPad, tablet, or phone, at this link:
https://www.spreaker.com/show/talking-later.
Crisis Line Support
If you are a veteran in crisis — or you’re concerned about one — free, confidential support is available 24/7. Call the Veterans Crisis Line at 1-800-273-8255 and press 1, send a text message to 838255, or chat online.
About the Authors
Kelly A. O’Malley, PhD, is the clinical director of the Mental Health Consult-Liaison Service at the VA Boston Community Living Center where she provides psychological services to aging veterans, supervises psychology interns and post-doctoral fellows, and oversees mental health services. Her research interests center on aging health policy, trauma-informed care, hospice and palliative care, and late-life PTSD. She is a Health and Aging Policy Alumna (2018-19) and she has an appointment to the Gerontological Society of America's Public Policy Advisory Panel.
Anica Pless Kaiser, PhD, is a clinical research psychologist in the Behavioral Science Division of the National Center for PTSD and a research assistant professor of psychiatry at Boston University School of Medicine. She is a co-director of the Stress, Health, and Aging Research Program (SHARP) group at VA Boston. Her research interests include understanding the effects of stress and trauma over the lifespan, PTSD symptom course over time, assessment of PTSD and related disorders, development of interventions for older veterans, and the relationships among trauma exposure, PTSD, and aging.
Rachel E. Weiskittle, PhD, is an associate professor, geropsychology, at the University of Colorado Colorado Springs. Dr. Weiskittle researches psychosocial factors influencing end-of-life experiences and adjustment to loss, with emphasis in developing translational clinical innovations for older adult, underserved, and minority communities. She is particularly interested in creative adaptations of educational and treatment methods through use of expressive arts and multimedia to address health service equity. Dr. Weiskittle led the development and is the host of the Talking Later podcast.
Lola K. Baird, MSW, LICSW, is a licensed independent clinical social worker (LICSW) in the state of Massachusetts with over 11 years of experience providing mental health and social work services. Her research interests include evaluating the structural systems that impact the lives and health outcomes of vulnerable populations. Ms. Baird’s goal is to create innovative interventions that will help mitigate the impact of structural disadvantage.
Hannah M. Bashian, MEd, PhD, is a clinical geropsychology post-doctoral fellow at the VA Boston Healthcare System. Her research interests include the impact of ageism across the lifespan and late-life PTSD.
Hannah L. Heintz, BA, is a research coordinator for the New England GRECC and was formerly the lab manager for the McLean Hospital Geriatric Psychiatry Research Program. Her research interests include risk factors for late-life mental illness and promotion of psychological wellbeing in older adults. Ms. Heintz will be starting the clinical psychology PhD program, behavioral medicine concentration, at Virginia Commonwealth University (VCU) in the Fall of 2022.
Anna G. Etchin, RN, PhD, is a baccalaureate-level registered nurse with a PhD in nursing from Northeastern University, Boston, Massachusetts. Her program of research focuses on post-9/11 U.S. veteran resilience and health functioning, particularly within the context of childhood and deployment trauma. She is committed to improving the holistic well-being of veterans as they reintegrate into civilian life.
Jennifer Moye, PhD, is a board certified geropsychologist; the associate director for education and evaluation, New England Geriatric Research Education and Clinical Center (GRECC); a professor of psychology at Harvard Medical School; an adjunct professor of psychiatry at BU School of Medicine; and editor-in-chief of the Clinical Gerontologist. Her recent research focuses on the re-emergence of PTSD symptoms in later life.
References
- Moye, J., Kaiser, A. P., Cook, J., & Pietrzak, R. H. (2021). Post-traumatic Stress Disorder in Older U.S. Military Veterans: Prevalence, Characteristics, and Psychiatric and Functional Burden. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, S1064-7481(21)00520-0. Advance online publication. doi:10.1016/j.jagp.2021.10.011
- Glaesmer, H., Gunzelmann, T., Braehler, E., Forstmeier, S., & Maercker, A. (2010). Traumatic experiences and post-traumatic stress disorder among elderly Germans: results of a representative population-based survey. Int Psychogeriatr, 22(4), 661-670. doi:10.1017/s104161021000027x
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). doi:10.1176/appi.books.9780890425596
- Davison, E.H., Kaiser, A.P., Spiro, A. 3rd, Moye, J., King, L.A., & King, D.W. (2016). From Late-Onset Stress Symptomatology to Later-Adulthood Trauma Reengagement in Aging Combat Veterans: Taking a Broader View. Gerontologist, 56(1):14-21. doi: 10.1093/geront/gnv097.
- Prince-Paul M, Peereboom K, Daly BJ. Confronting mortality: Narratives of military veterans enrolled in home hospice care. J Hosp Palliat Nurs. 2016;18(3):219-226. doi:10.1097/njh.0000000000000250
- Pietrzak, R. H., & Cook, J. M. (2013). Psychological resilience in older U.S. veterans: results from the national health and resilience in veterans study. Depression and anxiety, 30(5), 432–443. doi:10.1002/da.22083
- Nathan, S., Schwartz, A. W., & Topor, D. R. (2020). My Life, My Story: A Narrative Life History Activity to Humanize the Veteran Patient Experience. In Cases on Instructional Design and Performance Outcomes in Medical Education (pp. 70-91). IGI Global.