Advances in medicine have ensured Australians in general are living for longer than in previous generations. Australian Institute of Health and Welfare statistics from 2018 show the average life expectancy for males is now 80.4 years and 84.6 years for women. This is an increase in life expectancy of 1.7 years for men and 1.1 years for women during the past decade.
Among those Australians enjoying greater life expectancy are around 82,000 veterans who currently receive treatment through the Department of Veterans’ Affairs. About 25,000 are in their sixties, about 36,000 are aged in their seventies and 21,000 are over the age of 80.
For veterans, growing older can bring another layer of complexities due to the lasting effects of military service. This in turn can bring challenges for the physicians and health professionals supporting those ageing veterans who are living with mental health issues.
Age-related physical changes and the onset of diseases like hypertension, heart disease, osteoarthritis and cancers combine with self-worth type questions, such as ‘Have I had a meaningful life?’ and ‘What legacy will I leave?’ The lifestyle changes that are part and parcel of later life also need to be faced at some point – like retirement, illness, the death of loved ones, and decreasing independence.
For veterans diagnosed with posttraumatic stress disorder (PTSD), ageing can present greater challenges and in later years PTSD can re-emerge and the symptoms worsen. Depressive disorders commonly accompany PTSD, and are also common in the older population.
For some veterans, alcohol-related problems become an issue as the physiological changes that come with age mean the body is less able to tolerate the effects of alcohol.
Dementia is another key problem affecting older Australians and ageing veterans are at even greater risk of developing it. Recent research supports the view that the risk of developing dementia increases with the presence of PTSD and/or depressive disorders.
What does all this mean for the health practitioners who are supporting ageing veterans across Australia?
Dr Richard Bonwick and Dr Geoff Thompson, both consultant psychiatrists at the Anzac Centre, provide some examples of effective treatments that practitioners have at their disposal to help veterans.
- For PTSD, older veterans need ‘assertive’ management. This can include regular psychotherapy including trauma-focussed cognitive behavioural therapy, or eye movement desensitisation and reprocessing (EMDR).
- Medications for PTSD are still effective in ageing veterans but practitioners need to take care when prescribing medications to avoid drug interactions and side-effects.
- Regular exercise, intellectual stimulation and social activity and connectedness are also important to support good mental health and mental health treatment programs.
- Depression is most effectively treated with a mix of pharmacotherapy, psychotherapy and socialisation.
- For ageing veterans with alcohol-related disorders, the detoxification process can be more complicated, but specific drugs can be used safely, such as naltrexone, acamprosate and baclofen.
- Diagnosing dementia when PTSD and depression also exist is complex and needs specialists who can use neuroimaging, such as MRI and PET, and clinical neuropsychological testing.
Practical support and advice is available from the Centenary of Anzac Centre’s Practitioner Support Service. The service works with practitioners to improve the lives of veterans with mental health problems. It is a free, nationwide service that provides expert multidisciplinary support and guidance to health practitioners, organisations and other professionals working with veterans.
The Practitioner Support Service team includes specialist clinicians and clinically trained researchers with expertise in clinical and neuropsychology, general practice, social work, family therapy and psychiatry. Access to other experts can also be arranged, such as sleep and pain physicians and rehabilitation specialists.
Please contact the Centenary of Anzac Centre for advice when you need it. This is a free, confidential consultation service for practitioners and health professionals which can be accessed via email or telephone on 1800 VET 777.