OBJECTIVE: The aging experiences of military veterans provide critical insights into what successful aging is and means for later life contexts constrained by distinct health and social needs. Can veterans \'successfully\' age when they are exposed to so many stressors with serious health and social consequences for later life? Veterans can offer valuable lessons for developing comprehensive approaches to refining successful aging, ensuring inclusivity of different older populations. Building on Rowe and Kahn\'s idea of successful aging, we utilize the complementary concept of \'active aging\' to explore if there are unique factors, characteristics, and interventions that support active aging in veterans, compared to non-veteran populations.
METHODS: A rapid review and evidence synthesis was conducted across 9 databases in medicine, psychology, anthropology, sociology, and public health to search for peer-reviewed articles and research reports.
RESULTS: Findings suggest that programs linking health and social dimensions can support the active aging of veterans, namely interventions promoting active physical and cognitive lifestyle as well as social connectedness and engagement. Such programs and interventions help prevent and combat mental and physical health decline and increase quality of life and well-being.
CONCLUSIONS: Findings have implications for veteran and non-veteran populations more broadly, as people can actively age even when they have unique health and social needs.

UNASSIGNED: Posttraumatic stress disorder (PTSD) symptom reduction is linked with lower risk of incident type 2 diabetes (T2D), but little is known about the association between PTSD and comorbid T2D outcomes. Whether PTSD is a modifiable risk factor for adverse T2D outcomes is unknown.
UNASSIGNED: To determine whether patients with PTSD who improved and no longer met diagnostic criteria for PTSD had a lower risk of adverse T2D outcomes compared with patients with persistent PTSD.
UNASSIGNED: This retrospective cohort study used deidentified data from US Veterans Health Administration (VHA) historical medical records (from October 1, 2011, to September 30, 2022) to create a cohort of patients aged 18 to 80 years with comorbid PTSD and T2D. Data analysis was performed from March 1 to June 1, 2024.
UNASSIGNED: Diagnoses of PTSD and T2D.
UNASSIGNED: The main outcomes were insulin initiation, poor glycemic control, any microvascular complication, and all-cause mortality. Improvement of PTSD was defined as no longer meeting PTSD diagnostic criteria, per a PTSD Checklist score of less than 33. Entropy balancing controlled for confounding. Survival and competing risk models estimated the association between meeting PTSD criteria and T2D outcomes. Subgroup analyses examined variation by age, sex, race, PTSD severity, and comorbid depression status.
UNASSIGNED: The study cohort included 10 002 veterans. More than half of patients (65.3%) were aged older than 50 years and most (87.2%) were men. Patients identified as Black (31.6%), White (62.7%), or other race (5.7%). Before controlling for confounding with entropy balancing, patients who no longer met PTSD diagnostic criteria had similar incidence rates for starting insulin (22.4 vs 24.4 per 1000 person-years), poor glycemic control (137.1 vs 133.7 per 1000 person-years), any microvascular complication (108.4 vs 104.8 per 1000 person-years), and all-cause mortality (11.2 vs 11.0 per 1000 person-years) compared with patients with persistent PTSD. After controlling for confounding, no longer meeting PTSD criteria was associated with a lower risk of microvascular complications (hazard ratio [HR], 0.92 [95% CI, 0.85-0.99]). Among veterans aged 18 to 49 years, no longer meeting PTSD criteria was associated with a lower risk of insulin initiation (HR, 0.69 [95% CI, 0.53-0.88]) and all-cause mortality (HR, 0.39 [95% CI, 0.19-0.83]). Among patients without depression, no longer meeting PTSD criteria was associated with a lower risk of insulin initiation (HR, 0.73 [95% CI, 0.55-0.97]).
UNASSIGNED: The findings of this cohort study of patients with comorbid PTSD and T2D suggest that PTSD is a modifiable risk factor associated with a modest reduction in microvascular complications. Further research is needed to determine whether findings are similar in non-VHA health care settings.

Heart rate variability (HRV) is an index of cardiac autonomic function and an objective biomarker for stress and health. Improving HRV through biofeedback has proven effective in reducing symptoms of posttraumatic stress disorder (PTSD) and depression in veteran populations. Brief protocols involving fewer sessions can better maximize limited clinic resources; however, there is a dearth of knowledge on the number of clinical sessions needed to significantly reduce trauma and depression symptoms. We conducted a series of linear regression models using baseline, post-intervention, and follow-up data from intervention group participants (N = 18) who engaged in a pilot waitlist-controlled study testing the efficacy of a 3-session mobile app-adapted HRV biofeedback intervention for veterans with PTSD. Based on Nunan et al. (Pacing and Clinical Electrophysiology 33:1407-1417, 2010) short-term norms, we found that pre-intervention RMSSD in the normal range significantly predicted PTSD and depression symptom improvement. Findings suggest the utility of baseline RMSSD as a useful metric for predicting HRV biofeedback treatment outcomes for veterans with PTSD and comorbid depression. Those with below-normal baseline RMSSD may likely need additional sessions or an alternative treatment to show clinically meaningful symptom improvement.

OBJECTIVE: Understanding disease prevalence can inform treatment and resource needs across populations. This study aimed to identify the prevalence of sleep apnea (OSA) among veterans and nonveterans.
METHODS: The national Comparative Health Assessment Interview Study, cross-sectional survey using probability-based sampling frames.
METHODS: Surveys completed by Internet or phone.
METHODS: 15,166 veterans (40% response rate) and 4,654 nonveterans (57% response rate).
METHODS: Self-report of healthcare provider-based diagnosis of OSA.
METHODS: Calculation of prevalence of OSA using statistical weighting to allow for direct comparison between veterans and nonveterans. Secondary analyses evaluated OSA by deployment status among veterans and compared average age of OSA diagnosis and differences in OSA prevalence among veterans and nonveterans stratified by gender, marital status, race/ethnicity, and posttraumatic stress disorder diagnosis.
RESULTS: OSA diagnosis was more than twice as prevalent among veterans (21%, 95% CI 20%-22%) than nonveterans (9%, 95% CI 8%-10%; aOR: 2.56, 95% CI 2.22-2.95, P < .001). Deployment was associated with higher odds of OSA among veterans (aOR: 1.64, 95% CI 1.43-18.7, P < 001.) Veterans were diagnosed with OSA on average 5 years earlier than nonveterans.
CONCLUSIONS: Veterans have a high prevalence rate of OSA, highlighting the importance of veterans\' access to treatment. OSA is likely underdiagnosed in nonveterans, particularly among racial/ethnic minoritized groups. Future research should investigate disparities in access to diagnostic testing for racial/ethnic minority nonveterans and/or risk factors for OSA among racial/ethnic minority veterans. The increased odds of OSA among those with PTSD highlights in the importance of early referral for OSA testing by providers as well as development of trauma-informed strategies to promote OSA treatment adherence. Limitations include a bias toward underestimation of true disease prevalence due to self-report of diagnosis.

BACKGROUND: Time in healthcare facilities is associated with worse patient quality of life (QoL); however, impact on family caregiver QoL is unknown. We evaluate care recipient days not at home-days in the emergency department (ED), inpatient (IP) care, and post-acute care (PAC)-to understand how care recipient days not at home correspond to family caregiver QoL.
METHODS: Secondary data were linked to care recipient utilization data. Elastic net machine learning models were used to evaluate the impact of a single day of utilization in each setting on binary QoL outcomes. We also compared composite weighted and unweighted \"days not at home\" variables. Two time periods, 6 and 18 months, were used to predict three caregiver QoL measures (self-rated health, depressive symptoms, and subjective burden).
RESULTS: In the 6-month timeframe, a single day of ED utilization was associated with increased likelihood of poor QoL for all three assessed outcomes (range: 1.4%-3.2%). A day of PAC was associated to a modest degree with increased likelihood of caregiver burden (0.2%) and depressive symptoms (0.1%), with a slight protective effect for self-rated health (-0.1%). An IP day had a slight protective effect (-0.2 to -0.1%). At 18 months, ED and IP had similar, albeit more muted, relationships with caregiver burden and depressive symptoms. PAC had a slight protective effect for caregiver burden (-0.1%). Cumulative days in all settings combined generally was not associated with caregiver QoL.
CONCLUSIONS: Whereas total care recipient time away from home had some negative spillovers to family caregivers, the countervailing effects of unique settings on caregiver QoL may mask net QoL effects. This finding limits the utility of a single care recipient home time measure as a valid caregiver-centered measure. Considering cumulative care recipient time in individual settings separately may be needed to reveal the true net effects on caregiver QoL.

During the First World War, 2845 women served as nursing sisters with the Canadian Expeditionary Force. After the war, some women developed nervous and mental conditions that they said were caused by their wartime service and applied for military pensions and treatment. So how were these women treated by doctors and pension boards? Men who suffered from psychological trauma were frequently labelled as \"cowards\" or \"malingerers.\" Many of the symptoms typically associated with nervous cases, such as hysteria, were viewed as inherently feminine at the time but we know little about how this criterion was applied to female veterans. One hundred forty-three nursing sisters who applied for pensions reported that they suffered from mental and nervous illnesses. An examination of veteran pension files suggests that psychologically traumatized women were also judged based on gendered stereotypes and encountered similar barriers to male veterans in trying to prove that their conditions were attributable to their service. These findings reveal the unique challenges and trauma women faced long after the war had ended.
Abstrait. Pendant la Première Guerre mondiale, 2 845 femmes ont servi comme infirmières militaires au sein du Corps expéditionnaire canadien. Après la guerre, certaines ont développé des troubles nerveux et mentaux qui, selon elles, étaient causés par leur service en temps de guerre et ont demandé des pensions et des traitements militaires. Alors, comment ces femmes étaient-elles traitées par les médecins et les gestionnaires des fonds de pension? Les hommes qui souffraient de traumatismes psychologiques étaient souvent qualifiés de «lâches» ou de «simulateurs». Bon nombre des symptômes généralement associés aux cas nerveux, tels que l’hystérie, étaient considérés comme intrinsèquement féminins à l’époque, mais nous savons peu de choses sur la manière dont ce critère a été appliqué aux femmes vétérans. Cent quarante-trois infirmières qui ont demandé une pension ont déclaré souffrir de maladies mentales et nerveuses. L’examen des dossiers de pension des anciens combattants suggère que les femmes psychologiquement traumatisées ont également été jugées sur la base de stéréotypes sexistes et ont rencontré des obstacles similaires à ceux des vétérans masculins en essayant de prouver que leurs problèmes de santé étaient attribuables à leur service. Ces résultats révèlent les défis et traumatismes uniques auxquels les femmes ont été confrontées longtemps après la fin de la guerre.

UNASSIGNED: Mindfulness-based, in-person programs are effective at reducing stress and enhancing resilience in military and civilian samples, yet few studies have examined or compared training offered via real-time, interactive social media. Such a program would have a wider-reach and could include those unable to attend in-person. There is also interest in resolving ambiguity about the effects of mindfulness training on individual difference variables, such as self-compassion.
UNASSIGNED: The purpose of this research was to compare pre/post self-compassion for three interventions; Mindfulness-based Stress Reduction delivered in-person (IP), mindfulness meditation training delivered via a Virtual World (VW), and a wait-list Control Group (CG) among active duty and veteran U.S. military.
UNASSIGNED: A 2 (pre/post)×3 (group) factorial design was conducted with 250 active duty and veteran U.S. Military service members, with self-compassion measures as dependent variables.
UNASSIGNED: Self Compassion improved 10% for the IP group and 14% for the VW group, while the CG group did not improve. Combined treatment groups yielded a 10.3% improvement in self-compassion compared with no change in the CG and with a group×time interaction effect (p < 0.01). Participants with lower initial self-compassion experienced greater benefits than those with higher baseline self-compassion (p < 0.01).
UNASSIGNED: IP and VW Mindfulness Meditation training were equally effective in increasing self-compassion. Adding effective on-line mindfulness delivery will promote self-compassion among a more extensive audience, likely yielding improved coping, confidence, connectedness, cheerfulness, steadiness, and self-satisfaction, while lessening anxiety, fear-of-failure, and stress among participants.

This cross-sectional study examines the association of protective psychological characteristics with mental, psychosocial, cognitive, and physical functioning in military veterans.

BACKGROUND: Alzheimer\'s disease (AD) is associated with the accumulation of neuropathological beta-amyloid (Ab) plaques, which is thought to be caused by an imbalance between Ab overproduction and dysfunctional Ab clearance. Both animal and human studies have shown that increased cerebrospinal fluid (CSF) levels of Ab peptides, especially Ab-40 and Ab-38 due to their high solubility, may be indicative of overall Ab dysregulation in preclinical AD, years before pathological Ab plaques begin to aggregate. The apolipoprotein E (APOE) e4 allele, which is the strongest genetic risk factor for AD, has been linked to impaired Ab clearance and disruption of the amyloid precursor protein (APP) pathway that is responsible for Ab production. However, the association between early Ab dysregulation and other genetic risk variants remains understudied. Thus, we aimed to explore whether genetic risk for AD is related to early markers of Ab overproduction by examining associations between polygenic risk scores (PRS) and CSF Ab-40 and Ab-38 in an AD-vulnerable population.
METHODS: We selected 88 non-demented Veterans (Age: M = 68.22, SD = 3.75 years) from the Alzheimer\'s Disease Neuroimaging Initiative-Department of Defense (ADNI-DOD) database with available genetic markers and CSF measures for Ab-40 and Ab-38. Genetic propensity for AD was assessed using genome-wide PRS, both with and without the APOE region, employing a p-value threshold < 0.01. CSF Ab concentrations were measured using a 2D-UPLC-tandem mass spectrometry method outlined by ADNI-DOD. Partial spearman\'s correlations related PRS to CSF Ab-38 and Ab-40 levels adjusting for age.
RESULTS: CSF Ab-40 levels were positively associated with PRS for AD (rhopartial = 0.22, p = 0.037). When variants in the APOE region were excluded from the score, the relationship between CSF Ab-40 and PRS remained significant (rhopartial = 0.23, p = 0.035). The relationship between PRS for AD and CSF Ab-38 levels was not significant, regardless of whether APOE regions were included in the score (all p\'s > 0.1).
CONCLUSIONS: Genetic risk for AD may lead to early Ab overproduction, as evidenced by elevated CSF Ab levels, particularly Ab-40. Other genetic variants, in addition to APOE, may play an integral role in disrupting the APP pathway and dysregulating Ab production.

While musculoskeletal pain (MSP) stands as the most prevalent health condition among Veterans, timely and high-quality care is often hindered due to access barriers. Team Red, White & Blue (Team RWB), a nonprofit organization dedicated to promoting a healthier lifestyle among Veterans, aimed to assess innovative approaches to veteran care. This is a single-arm pilot study investigating the feasibility, clinical outcomes, engagement, and satisfaction of a remote multimodal digital care program among Veterans with MSP. The impact of deployment experience on outcomes was explored as a secondary aim. From 75 eligible Veterans, 61 started the program, reporting baseline pain frequently comorbid with mental distress. Program acceptance was suggested by the high completion rate (82%) and engagement levels, alongside high satisfaction (9.5/10, SD 1.0). Significant improvements were reported in all clinical outcomes: pain (1.98 points, 95%CI 0.13; 3.84, p = 0.036); mental distress, with those reporting at least moderate baseline depression ending the program with mild symptoms (8.50 points, 95%CI: 6.49; 10.51, p = 0.012); daily activity impairment (13.33 points, 95%CI 1.31; 25.34, p = 0.030). Deployed Veterans recovered similarly to their counterparts. Overall, the above results underscore the potential of a remote digital intervention to expand Veterans\' access to timely MSP care.