Study finds some veterans experience distress related to past trauma exposure as they near end of life

Exposure to a traumatic event may haunt you decades after the initial exposure.

Eighty-five percent of military veterans have been exposed to traumatic events and this puts them at elevated risk (ranging from one to 22 percent depending on the conflict era) for post-traumatic stress disorder (PTSD). While many veterans are resilient, a new study has found that those with trauma exposure experience greater trauma-related memories and PTSD symptoms as they near death.

"When PTSD and serious illness co-occur, PTSD may impact care, coping and common end-of-life symptoms," explains corresponding author Anica Pless Kaiser, Ph.D., clinical research psychologist at the National Center for PTSD at the VA Boston Healthcare System and a research assistant professor of psychiatry at Boston University School of Medicine.

Individuals with PTSD may be more likely to experience chronic pain and pain may exacerbate PTSD symptoms. Individuals with PTSD may use dysfunctional coping mechanisms, leading to increased distress in individuals with chronic medical conditions and dementia.

In an effort to better understand what PTSD symptoms were experienced by these Veterans at end of life, the researchers conducted 10 focus groups with hospice and palliative care clinicians who provide care for Veterans. The hospice and palliative care clinicians reported observing many symptoms and behaviors in this population consistent with re-experiencing of traumatic events, including intrusive memories, dreams/nightmares, flashbacks or dissociative reactions, and psychological distress in response to trauma reminders and cues. They also noted that re-experiencing sometimes occurred in tandem with dementia or delirium.

According to the researchers, this work is important because little is currently known about how PTSD looks in Veterans who are at the end of their lives. "Some providers may not recognize PTSD or be trained in how to appropriately assess and respond. Existing therapeutic approaches to treating PTSD may need to be modified to address the moral, spiritual and existential concerns that are often encountered as death nears," says Pless Kaiser.

The researchers believe future research is needed to understand and evaluate care for veterans with PTSD at end of life as well as their families.

These findings appear online in the journal Progress in Palliative Care.