Reverberations From War Complicate Vietnam Veterans' End-Of-Life Care

As Vietnam veterans age and develop terminal illnesses, the U.S. Department of Veterans Affairs' (VA) palliative care staff are facing more challenges, reports Kaiser Health News . Some veterans become stoic and less willing to admit they are afraid or in pain, and less willing to take treatment. Others with post-traumatic stress disorder (PTSD) are even more resistant to taking pain-relieving opioids because the drugs can exacerbate their symptoms. The VA's National Center for PTSD estimates about 70 percent of Vietnam vets have had PTSD in their lifetime, the highest rate among veteran groups, while various studies found this higher rate is attributable to the unusual combat conditions vets faced and the negative reception many of them got when they returned home. "They're so distracted trying to cope with their physical symptoms that they might have flashbacks," notes VJ Periyakoil at the VA Palo Alto Health Care Center. "War memories start coming back; they start having nightmares." Some vets also refuse pain-relieving medication because they feel as if they deserve the pain, says University of California-San Francisco Professor Eric Widera. He notes the VA has been attempting to implement end-of-life care earlier for vets in order to resolve their moral distress or PTSD years before they end up in hospice.