Geriatric Mental Health Disaster and Emergency Preparedness

Chapter 16 The Experience of Vulnerability in Geriatric Combat Veterans 321
lation to the rates of decline among the WWII and Korean War veterans
(U.S. Department of Veterans Affairs, 2008). To be more specific, the youngest
Vietnam veteran is 55 years old today, and the oldest Vietnam veteran
could be into his late 70s. Within the next several years, geriatric combat
veterans of the baby boomer generation may become the largest consumer
group of medical and mental health services and products.
INTERVENTIONS
The instrument commonly used to assess for combat trauma is the PCL-M
(Weathers, Husk, & Keane, 1991). This instrument is a 17-item list that
translates the DSM-IV-TR criteria for PTSD into questions, asking the
subject to indicate how much they have been bothered by each item in the
past month (Weathers, Husk, et al.). A score below 50 is considered subthreshold
for combat trauma (Weathers, Litz, Herman, Huska, & Keane,
1993). In addition to this widely used instrument, which is an integral part
of the monitoring process in the treatment of PTSD, often within the first
few sessions a structured interview for PTSD known as Clinical Aided,
PTSD, or CAPS (Blake, et al., 1998), is conducted. The CAPS is an extensive
evaluation that allows for greater objective assessment of the expression
of subjective symptoms experienced by the veteran.
A veteran may experience a period of symptom reduction after completing
a course of therapy in which one or two target symptoms were
addressed in the context of examining the veteran’s most traumatic experience.
Veterans who experience a reduction in symptoms endorse improved
familial, social, or industrial function. However, improvement does
not preclude the possibility of symptom exacerbation triggered by an external
event (Schnurr, 1994). These exacerbations may require a return to
therapy for stabilization. In some cases, further exploration of the cognitive
distortions and beliefs that may have surfaced is warranted.
Since the events of September 11, 2001, two subjects have taken center
stage in the therapeutic dialogue: the potential for another attack and,
after 2003, the wars in Iraq and Afghanistan. Veterans have utilized their
own capacities for resilience by drawing upon their experiences as survivors
of war and stepping into renewed roles as contributors, providers,
and protectors of their family and friends. For those who have yet to claim
this role, clinicians have focused on the enhancement of coping skills. At
the same time, veterans have been encouraged to address their underlying
feelings of anxiety and dread connected to unresolved, unconscious
beliefs about the present as related to the past.