Vulnerability and Resilience Among Older Adults During the COVID Pandemic

The COVID-19 pandemic is particularly challenging for many older adults. They are strongly encouraged to practice social distancing and sheltering in place to decrease morbidity and mortality risks. However, social isolation and loneliness increase the risk of mental and physical health problems. Nonetheless, there are indications that older adults may be more resilient than originally thought. Park et al. present longitudinal findings that younger adults fared worse than middle-aged or older ones, reporting greater distress and less social support, mindfulness, and emotion regulation skills. For older participants, acceptance of negative emotions and social support predicted lower distress. Choun et al. also present longitudinal data, showing that depressive symptoms decreased among older adults during the lockdown phase of the pandemic, but reflected changes in loneliness and physical health symptoms. Stellman et al. found that moderate levels of combat experience were helpful for some older Vietnam veterans coping with the pandemic, although a few found that it made coping more difficult. Turner et al. found that positive, non-familial intergenerational contacts were associated with a higher number of positive pandemic-related changes, such as finding new hobbies and meaning in work. Finally, Aldwin et al. present a social ecological approach to vulnerability and resilience. Using qualitative data, they found that stressors and resources were reported at personal, interpersonal and societal levels. Further, older adults both took comfort from and contributed to community resources during this pandemic. In summary, this symposium identified factors that contribute to older adults’ resilience during this pandemic.

Hospice Care for Veterans: A Community Education Program

The impact of trauma on care at end of life and the social isolation of the COVID-19 pandemic highlighted a critical gap in care of terminally ill veterans. It is estimated that 30% of Vietnam Veterans suffer from PTSD, suicide rates are 49% higher in older veterans than nonveterans, and 41% of veterans surveyed report post traumatic guilt. A survey of non-VA hospice agencies revealed many do not screen for PTSD, but desired training in this area. The VA responded to these challenges implementing an initiative to educate community caregivers on PTSD, suicide, and moral injury with expanded tele mental health services. Several VA sites were supported to participate in training focusing on PTSD, suicide, and moral injury and Telemental health. In Northeast Ohio, from 2019-20, 11 community hospice agencies participated in training, including 283 providers,120 (42%) nurses, 100 (35%) social workers, 29 (10%) volunteers, and 34 (12%) other. A majority of participants post-training (n=160) (84%-94%) reported enhanced knowledge, skills, or attitudes related to resources, education, and communication. Participants rated changes for assessment skills lowest for moral injury (34%), PTSD (41%), and suicide (56%). An analysis of telemental health visits (N=50) revealed that, 56% addressed spiritual support, (22%) family support, (10%) resources/referrals, and (8%) confusion. The majority of telehealth visits were VA initiated (84%), and 10% were hospice initiated Continued education regarding PTSD, suicide, and moral injury assessment skills is still needed for hospice care providers of veterans. These findings support the use of telemental health for care and consultation.

Correlates of Psychological Well-being Among Korean Vietnam War Veterans

Prior research on Veterans’ mental health has largely focused on identifying risk and protective factors for negative psychological symptoms such as PTSD. However, mental health indicates not merely absence of psychopathology, but also the existence of positive psychological well-being (Keyes, 2005). Thus, the current study aimed to examine the correlates of psychological well-being, which is less studied, in an Asian sample, Korean veterans. Data for this 2017 study were from Korean Vietnam War Veterans Study. Participants were 348 male veterans, and their mean age was about 72 years old (SD = 2.7, range = 65-84). Using Keyes’ (2002) classification criteria, psychological well-being was divided into three types: flourishing (9.5%), moderately health (59.95%), and languishing (25.3%). Own-way analyses of variance showed that the groups did not differ in demographic variables (age, marital status, education, and income). Further, there were no differences in combat exposure, negative appraisals of military service, smoking, and alcohol consumption. However, significant group differences were found for resources; Scheffé's post-hoc analyses indicated that optimism, positive appraisals of military service, four types of social support (family, significant others, friend, and military peer), and self-rated health were significantly different among the groups, and highest in the flourishing group. The moderately health group showed higher levels of positive appraisals of military service and four types of social support than the languishing group. Thus, the majority (about 60%) of Korean Vietnam veterans were moderately psychologically healthy in this sample, but those with positive psychosocial resources were more likely to be healthiest.

Coping With COVID: Does Prior Military Service Play a Role for Vietnam Veterans?

We investigated the impact of earlier military combat on ability to cope with the COVID-19 pandemic in 379 male Vietnam veterans who responded to surveys in 1984, 1998, and 2020. Combat exposure was scored with a validated scale, contrasting lowest tertile (8-15) vs. medium/high (16-40). About one-fourth of veterans (26%) reported that their military experience made it easier to cope with the pandemic, while over half (59%) said it had no effect. Medium/high-combat veterans were more likely to report that their military experience made coping easier (OR = 1.8, p = 0.03), but were less likely to report no effect of service on their coping than low-combat veterans (OR = 0.40, p<0.001). All 19 respondents (5%) who said military experience made coping more difficult were medium/high combat veterans. Military experience, and combat particularly, affected many of these veterans’ ability to cope with the pandemic decades after their service.

The Architecture of Pilgrimage: Sacred Site and Sacred Self in the Quest for Meaning

<p>As an historic cultural phenomenon that has been practiced throughout the globe for centuries, from ancient Greeks through to Vietnam veterans, the practise of pilgrimage has undergone a renaissance in the last few decades. This revival has seen the definition of pilgrimage re-examined and re-evaluated in terms that reflect the contemporary positions of religion and spirituality in society. It is up to the individual now to decide what they consider to be sacred and where they will find value and meaningfulness (Reader, 2007). As one of the oldest forms of seeking meaning and meaningfulness, pilgrimage is intimately connected with the human need and desire to become "complete embodied and spiritual beings" (Pallasmaa, 2005). So too is architecture concerned with our ability to find and occupy a meaningful existence. Yet the relationship between architecture and pilgrimage hasn't yet been explored in a meaningful manner. By exploring the concept of pilgrimage, this research aims at demonstrating how pilgrimage can be used to anchor meaning and meaningfulness in architecture. This aim is investigated though the design of a hospice facility. Architecture and pilgrimage are both concerned with humanity's search and desire for meaning and meaningfulness; pilgrimage, as a metaphor for life and as the physical act of journeying in order to find meaning; architecture and its ability to allow us to have, be and create meaningful experiences within our everyday lives.</p>

The Architecture of Pilgrimage: Sacred Site and Sacred Self in the Quest for Meaning

<p>As an historic cultural phenomenon that has been practiced throughout the globe for centuries, from ancient Greeks through to Vietnam veterans, the practise of pilgrimage has undergone a renaissance in the last few decades. This revival has seen the definition of pilgrimage re-examined and re-evaluated in terms that reflect the contemporary positions of religion and spirituality in society. It is up to the individual now to decide what they consider to be sacred and where they will find value and meaningfulness (Reader, 2007). As one of the oldest forms of seeking meaning and meaningfulness, pilgrimage is intimately connected with the human need and desire to become "complete embodied and spiritual beings" (Pallasmaa, 2005). So too is architecture concerned with our ability to find and occupy a meaningful existence. Yet the relationship between architecture and pilgrimage hasn't yet been explored in a meaningful manner. By exploring the concept of pilgrimage, this research aims at demonstrating how pilgrimage can be used to anchor meaning and meaningfulness in architecture. This aim is investigated though the design of a hospice facility. Architecture and pilgrimage are both concerned with humanity's search and desire for meaning and meaningfulness; pilgrimage, as a metaphor for life and as the physical act of journeying in order to find meaning; architecture and its ability to allow us to have, be and create meaningful experiences within our everyday lives.</p>

Association of Potential for Deaths of Despair With Age and Military Service Era

ABSTRACT Introduction Predictors of deaths of despair, including substance use disorder, psychological distress, and suicidality, are known to be elevated among young adults and recent military veterans. Limited information is available to distinguish age effects from service-era effects. We assessed these effects on indicators of potential for deaths of despair in a large national sample of U.S. adults aged ≥19 years. Materials and Methods The study was a retrospective, cross-sectional analysis of publicly available data for 2015-2019 from 201,846 respondents to the National Survey on Drug Use and Health (NSDUH), which measures psychological symptoms and substance use behaviors using standardized scales and diagnostic definitions. Indicators of potential for a death of despair included liver cirrhosis, past-year serious suicidal ideation, serious psychological distress per the Kessler-6 scale, and active substance use disorder (e.g., binge drinking on ≥5 occasions in the past month, nonmedical use of prescribed controlled substances, and illicit drug use). Bivariate, age-stratified bivariate, and multivariate logistic regression analyses were performed using statistical software and tests appropriate for the NSDUH complex sampling design. Covariates included demographic characteristics, chronic conditions, and religious service attendance. Results Indicators were strongly and consistently age-associated, with ≥1 indicator experienced by 45.5% of respondents aged 19-25 years and 10.7% of those aged ≥65 years (P &lt; .01). After age stratification, service-era effects were modest and occurred only among adults aged ≥35 years. The largest service-associated increase was among adults aged 35-49 years; service beginning or after 1975 was associated (P &lt; .01), with increased prevalence of ≥1 indicator (30.2%-34.2% for veterans and 25.2% for nonveterans) or ≥2 indicators (6.4%-8.2% for veterans and 5.4% for nonveterans). Covariate-adjusted results were similar, with adjusted probabilities of ≥1 indicator declining steadily with increasing age: among those 19-34 years, 39.9% of nonveterans and 42.2% of Persian Gulf/Afghanistan veterans; among those aged ≥65 years, 10.3% of nonveterans, 9.2% of World War II/Korea veterans, and 14.4% of Vietnam veterans. Conclusions After accounting for age, military service-era effects on potential for a death of despair were modest but discernible. Because underlying causes of deaths of despair may vary by service era (e.g., hostility to Vietnam service experienced by older adults versus environmental exposures in the Persian Gulf and Afghanistan), providers treating veterans of different ages should be sensitive to era-related effects. Findings suggest the importance of querying for symptoms of mental distress and actively engaging affected individuals, veteran or nonveteran, in appropriate treatment to prevent deaths of despair.