Mental Health Needs of Aging Veterans: Recent Evidence and Clinical Recommendations

ABSTRACT

Objectives: Large numbers of older Americans have a history of military service, which may be positively or negatively associated with mental health in late life. We reviewed literature with the aim of better understanding the mental health needs of older Veterans.

Methods: Articles included those published in 2009–2018 and focused on prevalence/risk for mental illness and suicide among older Veterans; utilization of mental health services; effectiveness of evidence-based behavioral treatments; and pertinent care delivery models.

Results: Older Veterans are generally resilient. A significant minority experience mental health concerns that are associated with poor outcomes including a substantial number of suicides. Most published research is based on the approximately one third of Veterans who use the Veterans Health Administration (VHA) for care. Older Veterans with mental health diagnoses are less likely to utilize mental health services compared to younger Veterans, but as likely to benefit once engaged. Integrated care models in primary and geriatric care settings are promising.

Conclusions: Aging Veterans are a large subset of Americans whose mental health needs are complex and deserve attention.

Clinical Implications: Clinicians should ask about history of military service (i.e., Veteran status) and utilize available resources when providing care for older Veterans.

KEYWORDS:

• Veterans
• mental health
• older adults
• Veterans Health Administration
• research review

Clinical Implications

• Older Veterans who, while generally resilient, are less likely than younger Veterans to access mental health services from which they might benefit.

• Clinicians and administrators serving older adults should be aware of military service as a potentially important aspect of life history, with implications for personal strengths and mental health concerns.

• Older Veterans who die by suicide are likely to die by firearm; it is important to discuss lethal means safety with those at risk for suicide.

Acknowledgments

The authors would like to thank Erin Wright for her valuable editing assistance.

Disclaimer

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. Note that this review began as a VHA administrative project, reviewing literature through 2016, to inform VHA research recommendations and convening of a virtual VHA geriatric mental health research conference. We realized it was important to publish our findings and subsequently updated the review through 2018.

2. A possible mental illness is any type of mental illness (not including dementia or tobacco use disorder) reported in any diagnostic field during that year. A confirmed mental illness is defined as at least two outpatient encounters, one of which must be in-person, or an inpatient/residential stay, with any mental health diagnosis in any diagnostic field.

Additional information

Funding

Writing of this manuscript was supported by the Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office (VACO) and the Veterans Integrated Service Network (VISN) 2 Center for Integrated Healthcare.