Military Caregivers: Cornerstones of Support for Our Nation's Wounded, Ill, and Injured Veterans

Abstract

S u m m a ry ■ The United States has been at war longer than any time in its history. While thousands have been wounded in this long-running conflict, advances in battlefield medicine mean many of our troops survive catastrophic wounds. The nature of many of their wounds, however, means some require long-term caregiving support. Those caregivers often toil in relative obscurity, and they are challenging to count or describe. They are spouses, parents, children, and relatives of the wounded veteran, but many coworkers, neighbors, and friends also take on responsibilities. They provide care and assistance, promoting faster recovery for their loved ones and thus saving our nation millions of dollars in health care costs. However, the personal impact of providing this care is enormous. The time required can result in lost jobs, lost wages, and a possible loss of health insurance; in addition, the physical and emotional toll can be substantial. The Elizabeth Dole Foundation commissioned the RAND Corporation to assess the needs of military caregivers, scan the services available to them, and identify how their needs are-and are not-being met. This report reviews existing research on the needs of caregivers in general, and assesses how lessons learned can be applied to military caregivers. This knowledge will inform policy and program development in the short term. We also present information gleaned from military caregivers themselves and from policymakers and program officials who either directly support, or advocate on behalf of, military

Sleep in caregivers

“…Their veteran care-receivers are typically younger and have unique comorbid conditions such as traumatic brain injuries, posttraumatic stress disorder, and more depression and anxiety than carereceivers in the general population. These morbidities require caregivers to provide heavy assistance with daily activities, mental/emotional support, and to navigate multiple healthcare systems to obtain needed services for their care-receiver [42]. In a study of older veterans participating in Adult Day Healthcare to increase socialization and provide daytime caregiver 'respite,' 38% had insomnia, and those with insomnia attended the Adult Day Healthcare less frequently, potentially increasing caregiver burden [43].…”

Beyond sensors

“…First and foremost, the app is meant for use by caregivers as well as the patient. In general, the importance of caregivers and awareness of their status is generally underestimated in mental health care [3] and their inclusion is not usually supported in the typical clinical care model. Yet caregivers can be an important data source about both the patient, but also about themselves (which in turn, relates to the patient).…”

“…Moreover, it can often be helpful for clinicians to understand the caregiver's status, since caregiver feelings and behavior can have dramatic effects on patients during treatment and in the future. [3] We are a multi-disciplinary team actively exploring methods for better quantification and reporting of mental health related measures, such as those described earlier. In doing so, we have designed a system for including caregivers as well as patients in a personalized, family-centered mobile medical care application for patients with PTSD/mTBI.…”

Military Service, War, and Families: Considerations for Child Development, Prevention and Intervention, and Public Health Policy

“…For an all-volunteer force engaged in prolonged wartime operations, multiple deployments may cumulatively span years across a child and family’s development (Maholmes, 2012). Research on returning service members demonstrate an increased risk (estimated to be up to 30%) for combat-related psychological health problems and traumatic brain injuries (Adamson et al 2011, Tanelian et al, 2013), and the risk for suicide within the veteran population continues to rise, with recent reports documenting 22 suicide related deaths reported each day (Kemp and Bossarte, 2012). Furthermore, advances in injury care have improved survival rates for severe physical injuries, with long-term implications for service members, veterans and their caregiving families (Tanelian et al, 2013).…”

“…Research on returning service members demonstrate an increased risk (estimated to be up to 30%) for combat-related psychological health problems and traumatic brain injuries (Adamson et al 2011, Tanelian et al, 2013), and the risk for suicide within the veteran population continues to rise, with recent reports documenting 22 suicide related deaths reported each day (Kemp and Bossarte, 2012). Furthermore, advances in injury care have improved survival rates for severe physical injuries, with long-term implications for service members, veterans and their caregiving families (Tanelian et al, 2013). Just as for service members serving in wartime operations, families too may experience the hardships of deployment and reintegration transitions in the context of dangerous duties.…”