Development, adaptation, and clinical implementation of the Later-Adulthood Trauma Reengagement (LATR) group intervention for older veterans.

Abstract

Later in life Veterans may report increased thoughts and memories of traumatic military experience in the context of age-related changes, a process called Later-Adulthood Trauma Reengagement (LATR); this process may lead to resilience or distress. We describe the development of a 10-session group intervention with goals of providing psychoeducation about LATR, enhancing stress management and coping skills, and fostering meaning making. We characterize implementation and outcome characteristics for seven group cohorts over 5 years; groups were completed in-person or virtually. Outcomes were measured with the Connor-Davidson Resilience Scale, Meaning in Life Scale, Satisfaction with Life Scale, Positive Appraisals of Military experience (PAMES), Posttraumatic Stress Disorder Checklist-5, and Patient Health Questionnaire-9. Forty-seven Veterans (aged 65-93) began the group, 37 (87%) completed at least six sessions. These 37 Veterans reported an average of eight stressful events in the prior year, mostly major illness, death of a friend, and decline in memory and enjoyable activities, which may have set the stage for LATR. Veterans resonated with the LATR concept on standardized scales and qualitative comments. In pre-post comparisons, participants reported higher levels of PAMES (η 2 = .225), resilience (η 2 = .208), and meaning in life (η 2 = .145), with fewer symptoms of PTSD (η 2 = .199) and depression (η 2 = .124). There were no significant differences in outcomes for those who completed the group in-person or virtually. The LATR protocol may provide a framework for working with older adults reporting emergence or exacerbation of thoughts and memories of earlier trauma in later life, fostering positive adaptation. Impact StatementAs people age, they may engage in life review; for Veterans this may bring new or increased thoughts about military service. We developed a group intervention to educate Veterans about Later-Adulthood Trauma Reengagement (LATR) and to provide tools for stress management and meaning making. Veterans who completed the intervention reported increased resilience, meaning in life, and positive views of military service, and decreased distress, suggesting the group may be useful to older Veterans experiencing LATR.

Preparing Veterans Health Administration Psychologists to Meet the Complex Needs of Aging Veterans

“…Mental health clinicians with specialty expertise and training in aging and lifespan development can facilitate positive outcomes to reduce distress. 7 The United States in general, and the VHA specifically, face a growing shortage of geriatric mental health clinicians. In a 2015 American Psychological Association survey, 1528 of 4109 respondents (37.2%) reported they frequently or very frequently administered care to older adults, yet only 49 respondents (1.2%) reported geropsychology as their specialty.…”