Core findings and lessons from the United Kingdom

An annual population survey of veterans residing in Great Britain in 2015 reveals that there was a difference in the health conditions of those below the age of 65 and above (The Ministry of Defense UK. 2015). Those of working age (under 65) did not view their general health differently from the non-veteran population. In fact, they viewed then^- general health as good and very good more or less similarly (74.3% versus 77.7% respectively). The top three reported conditions across working age veterans and non-veterans were heart-, blood pressure-, or circulatory-related conditions (34.4% and 33.9% respectively), leg- or feet-related conditions (33.1% and 26.7% respectively), and back- or neck-related conditions (32.0% and 24.6% respectively). Perceptions of general good and very good health chopped for veterans and non-veterans at retirement age (65+) to 53.9% for veterans and 59% for non-veterans, without a statistical significance between the two. There was no statistical difference between the retirement age veterans and non-veterans in relation to the percentage who reported a long-term health condition (50.5% and 47.9% respectively), nor was there any difference for each long-term health condition.

The top three reported conditions across retirement age veterans and non-veterans were heart-, blood pressure-, or circulatory-related conditions (53.9% and 54.5% respectively), leg- or foot-related conditions (40% and 34.2% respectively), and ami- or hand-related conditions (25.1% and 22.5% respectively).

A recent study by Fear, Wood, and Wessely (2009) reveals that UK ex-servicemen and women have higher rates of alcohol use compared to the mid-life general population. Alcohol problems, depression, and anxiety disorders are the most frequent mental health issues for ex-service personnel. Military personnel with mental health problems ar e more likely to leave their service over a given period compar ed to those without these problems and are at a higher risk of poorer outcomes post-service. Studies on delayed-onset PTSD are based on small samples and are mostly retrospective and should be treated with caution. Poor mental health outcomes are associated with deployment to Iraq or Afghanistan for personnel with pre-service vulnerabilities, those exposed to liigli levels of combat, and reservists compared with regulars.

Similarly, Murphy et al. (2017) reported that these mid-life veterans expressed symptoms of PTSD followed by problems with anger (74%), common mental health difficulties (72%), and alcohol misuse (43%). Comorbidity was frequent, with 32% of those with PTSD meeting criteria for three other health outcomes versus only 5% with PTSD alone. Aside from the complexity of presentations, these veterans postpone treatment outcomes that may result in them having serious difficulties in handling family and social problems hi their transition to aging.

The most covered area of aging military' veterans with disabilities in the United Kingdom is research on limb loss (Caddick et al., 2019). UK veterans with physical disabilities are often cited as struggling against decline or living as normal people in expressing then^- efforts to overcome the impact of severe life-course impairments (Cooper et al., 2018).

Two studies (Desmond, 2007; Desmond & MacLachlan, 2006) provide insights regarding psychosocial adaptation among older limbless veterans. Desmond and MacLachlan (2006) surveyed coping strategies and psychosocial adaptation with a sample of elderly lower-limb amputees (mean age = 74 years) who were members of the British Limbless Ex-Servicemen’s Association. Psychosocial adaptation was described in relation to an individual’s ability to adapt to a range of challenges including impairments in physical functioning, prosthesis use. pain, changes in occupation, and alterations in body image and self-concept. The authors reported that a lack of solving problems and of seeking social support were associated with more depressive symptoms and low psychosocial adaptation among older veteran amputees. Most of the avoidant veterans who used denial showed poor psychosocial adjustment, including excessive alcohol use.

In a separate study. Desmond (2007) explored coping and adjustment with upper limb amputees using a sample obtained from the British Limbless Ex-Servicemen’s Association. The prevalence of depression (28.3%) and anxiety symptoms (35.5%) was higher than rates reported in a non-clinical sample broadly representative of UK adults (Crawford et al., 2001). The findings indicate the importance of coping styles as predictors of psychosocial adaptation. In particular, avoidance was strongly associated with psychological distress and poor adjustment. The research suggests reducing reliance on avoidant coping and enhancing problem-focused approaches to coping with difficulties and challenges in order to facilitate adaptation and prevent problems in psychosocial functioning.

A recent study (Edwards et al., 2015) discusses the long-term economic cost of British amputees from the Afghanistan conflict, particularly those with complex wounds such as multiple amputations, including the impact of aging. Unlike the United States, which has a separate funding source for veterans through the VA, the service delivery in the United Kingdom is predominantly delivered by the NHS, supplemented or supported by third-sector organizations such as Blesma, The Limbless Veterans. Therefore, life-long planning has to be taken into consideration to avoid underfunding and a lack of rehabilitation and provision for midlife and aging veterans with multiple amputations.