The Veteran population is rapidly aging with 9.2 million veterans who are 65 years of age and older (See Table below). 1.4 million Veterans are “old-old” i.e. 85 years or older. Most of the illness burdens borne by Veterans are due to chronic illnesses like cancer, heart disease, lung disease, stroke and Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease). Due to exposure to toxins like Agent Orange, Veterans are at high risk for diseases like ALS and Prostate Cancer.

Source: Dept. of Veterans Affairs.

The Veteran population is becoming very diverse. The population of minority veterans is projected to increase significantly over the next few decades ( see figure below). The women Veteran population, which is currently estimated to be about 9% is expected to almost double in the next few decades.

Minority Veteran Population is on the Rise

In additional to the cultural needs based on ethnic background, there are specific behaviors more common in Veterans due to the training and experiences related to serving in the armed forces which can manifest with specific behaviors like battlemind, for example.

Battlemind is defined as a soldier’s inner strength to face fear and adversity during combat, with courage. It is the will to persevere and win. When on a tour of duty, a person is expected to be strong and fully operational at all times. There is a strong stigma associated with any show of weakness. They cannot back away from the war front.

When faced with physical threats due to serious illness, Veterans often work hard to meet the illness related challenges with courage and stoicism. Data show that Veterans, as a cultural group, are at a higher risk for post traumatic stress disorder, depression, and substance abuse. The cluster of these experiences will likely influence how pain, illness and end of life issues are experienced and interpreted.

As we prepare to care for the changing Veteran population and as they become increasingly older and are living with various chronic illnesses, there is a great need for high quality geriatric and palliative care that is tailored to the culture of veterans of diverse backgrounds and their families. System based strategies need to be further developed to promote early palliative care to all Veterans with serious illness. In a recent study analyzing indicators of care quality in Veterans with advanced cancer, addressing pain, non-pain symptoms, and advance care planning, only 17.7% of veterans had goals of care addressed in the month after a diagnosis of advanced cancer, and 63.7% had timely discussion of goals following intensive care unit admission. Most decedents (86.4%) were referred to palliative care or hospice before death.

Much work that needs to be done in order to provide high quality, culturally tailored geriatric palliative care to all Veterans with serious illness. The good news is that the VA is leading the way nationally and serving as a best practice for what can be accomplished when there is strategic and tactical planning and strong partnerships between line staff caring for patients and the leaders who are designing and resourcing care in the local facilities as well as the national office in Washington DC.

Resources: What to do

a. If you are a Veteran or a family member looking for geriatric and palliative care services, a good place to start is the VA Geriatrics Portal

b. Call the VA facility closest to you and enroll first ( if you are not already enrolled). Next ask to make an appointment with a primary care provider.

c. Ask your doctor to refer you to palliative care specialists if you have a serious illness.