Is the next war for rural veterans coming to a rural community near you? According the National Center for Veterans Analysis and Statistics, of the 19.4 million veterans living in the United States, approximately 24% live in rural or highly rural areas. Recent studies put both rural dwellers and those who have sustained traumatic brain injuries (TBIs), including concussions, at higher risk for developing Alzheimer's disease or dementia. The effects of head trauma in contact sports have headlined the news in recent years, but less attention has been given to veterans who have sustained TBIs, posttraumatic stress disorder (PTSD), and depression as a result of roadside bomb blasts and combat conditions that few of us can imagine. Qureshi and colleagues, writing in the Journal of the American Geriatrics Society (2010), found that veterans with a diagnosis of PTSD had twice the risk of developing dementia as veterans without PTSD. In addition, there's growing evidence that veterans who've sustained both moderate and severe TBIs have an increased risk of developing Alzheimer's disease and related dementias. Because of these and other risk factors, such as overall lower education levels and higher obesity rates, rural veterans may be at a significantly heightened risk for developing Alzheimer's or dementia, in some cases at younger ages than in the general population. These service members, along with their families and communities, may eventually find themselves facing a new enemy they are unprepared to fight.
Many rural communities lack specialty Veterans Affairs (VA) services and other types of social support. In addition, barriers of access and geographic isolation may necessitate care in the rural community rather than at VA facilities. Health care professionals and unlicensed personnel may also lack specialized training and cultural competence to care for rural veterans with early dementia. A study by Thorpe and colleagues in the Journal of Rural Health (2010) found that rural veterans with dementia had more avoidable hospital admissions than both rural nonveterans with dementia and urban veterans with dementia, suggesting that lack of access to culturally competent ambulatory care may have more severe clinical consequences in this population.
Without needed health care and support, families caring for rural veterans with dementia may find it necessary to move to urban areas where VA services, dementia specialty care, and social support programs are more readily available. Moving far from home, however, adds additional stress for veterans and their families.
Rural communities that fail to prepare for this crisis may lose veterans and families. Proactive, nurse-led campaigns that advocate for rural veterans with dementia and their families are needed and include
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- organizing meetings with community leaders, health professionals, businesses, and veterans; determining future interventions and an actionable plan for implementation.
- acknowledging rural veterans with dementia as a vulnerable population.
- dispelling myths about rural veterans’ access to health care. Not all veterans are eligible or elect to receive care at VA facilities, and not all veterans are covered by TRICARE, the military equivalent of health insurance.
- promoting routine dementia screening for rural veterans with a history of TBI and depression and/or PTSD. Early identification provides the opportunity for earlier intervention.
- educating health care professionals and the public on rural veterans as a vulnerable population in need of better support systems. Most important, proactive nurse leadership shows rural veterans and their families we value their sacrifice and will not leave any veteran behind.