Journal shares discoveries on women veterans' long-term health outcomes

A new supplemental issue of The Gerontologist contains 13 articles by Veterans Affairs (VA) researchers and colleagues looking at differences in aging and mortality between veteran and non-veteran women.

The findings are taken from the Women's Health Initiative (WHI), a long-term study funded by the National Institutes of Health's National Heart, Lung, and Blood Institute and begun in 1991. The study included more than 3,700 women veterans among nearly 162,000 postmenopausal women from 40 centers across the U.S. WHI researchers collected data on health status, disease, health behaviors, and social and psychological factors, following the women for more than two decades.

Gayle Reiber, PhD, MPH, a senior career scientist at the VA Puget Sound Health Care System, and Andrea LaCroix, PhD, MPH, professor and chief of epidemiology at the University of California, San Diego, and a senior investigator at the WHI Clinical Coordinating Center, worked with 60 VA and non-VA researchers to compare health and mortality between veterans and non-veterans in the sample.

"The women veterans in WHI have taught us that prior military service identifies a group of women who face special challenges as they grow older," said LaCroix. "With women choosing to serve our country in greater numbers and expanded roles including combat, it is essential to learn about their healthcare needs after leaving service now and in the future."

Among the findings:

• Women veterans reported lower levels of self-perceived health, life satisfaction, social support, physical function, and quality of life.
• Women veterans and non-veterans were similar at baseline in mental function tests, but declines in cognitive function over time were greater in the veteran group.
• Women veterans experienced higher hip-fracture rates than non-veterans, but this was not the case for other types of fractures.
• Women veterans smoked more and were exposed to more passive smoke, which resulted in a greater risk for lung cancer.
• All-cause mortality rates were higher for veterans, but only for those serving before the Vietnam era.
• Women veterans serving before the Vietnam era experienced more cancer, relative to non-veterans, whereas those serving during or after Vietnam had more traumas from motor vehicle accidents or other causes.

The researchers said the findings, on the whole, suggest that many women veterans could benefit from programs promoting physical activity, social connections, healthy weight, and smoking cessation. The researchers also stressed the importance of evaluation for depression.

The VA's Office of Women's Health leads efforts within the agency to identify women Veterans' health-related needs and improve their health care.

Reiber said there are several reasons why health outcomes may differ between veteran and non-veteran women as they age. The "healthy soldier effect"—the notion that military populations tend to be healthier in general than their non-military counterparts—may be offset by other factors, she explained.

"Women veterans were considered 'healthy soldiers,' since joining the military meant passing a variety of tests—education, aptitude, physical ability, mental function. It also meant maintaining physical fitness, and receiving health care," Reiber said. "Yet women veterans may have been more likely to engage in health behaviors such as smoking, alcohol use, and poor diet, and this, combined with exposure to hazardous environments and mental and physical stress, may have limited their ability to adapt to repeated stresses over the lifetime."

Reiber added that while the authors "cannot pinpoint all of the reasons for health differences among women Veterans compared with non-Veterans, these findings do identify ways to improve health and health care for this special group of older women."