10 Older Adults 285The loss of functioning was limiting his independence and in response, he was
becoming withdrawn and despondent, showing signs of depression.
My understanding of military culture, much like understanding any
other cultural perspective, facilitated the work with Wesley. Wesley chose to
not speak of his military experience over the years most likely for several rea-
sons. First, the duty to serve the country but not to stand apart from comrades
with any special need is a critical part of military cultural norms; second, the
trauma he suffered in seeing his best friend die in wartime remained influen-
tial in silencing him. Stoicism is a characteristic of many of the WWII veterans.
The VA has found that veterans with osteoarthritis of the knee and/or hip,
between the ages of 70 and 79 are more likely than younger counterparts to
suffer in silence through pain caused by medical conditions or refuse medica-
tion (Appelt, Burant, Siminoff, Kwoh, & Ibrahim, 2007). This was evidenced
in Wesley’s lack of expression of pain in response to his much compromised
physical condition. Wesley’s early resistance to being interviewed and his
begrudging cooperation were clearly self-protective to deter discussion of his
painful past but also due to a culture of privacy and need to avoid individual
recognition for his past. This forces clinicians to be more persistent, yet respect-
ful, in addressing both physical and mental pain treatment and management.
INTERVENTIONS
The work with Wesley was focused on his end of life issues as well as his
trauma history. Like many trauma survivors, he suppressed and avoided dis-
cussion of the traumatic event as a way to cope with the trauma. The acknowl-
edgment of Wesley’s status as veteran was key to his care. The Military History
Checklist (Department of Veteran Affairs, 2014) assists non-VA programs and
organizations to identify veterans in their client populations to evaluate the
impact of the military experience and determine if there are benefits to which
the veteran and surviving dependents may be entitled. Questions included
are: (1) Did you (or your spouse or family member) serve in the military?;
(2) In which branch of the military did you serve?; (3) In which war era or
period of service did you serve?; (4) Overall how do you view your experience
in the military?; (5) Would you like your hospice staff/volunteer to have mili-
tary experience, if available?; (6) Are you enrolled in VA?; (6a) Do you receive
any VA benefits?; (6b) Do you have a service connected condition?; (6c) Do you
get your medications from the VA?; and (6d/6e) What is the name of your VA
facility or VA provider?
Interventions with the older veteran, as with many of this age group,
may find the client holding a more positive outlook or response pattern report-
ing, “Everything is fine.” Sherwood, Shimel, Stolz, & Sherwood (2003) suggest
that more direct questions such as “Do you still think about the war and feel
sad?” are more helpful in assessing the client’s actual well-being. The direct
question communicates that the worker is ready to discuss military service.
The worker can follow-up with a question such as “What do you tend to
think about?” and “How much have you talked about your experiences with
other people?” If we as clinicians avoid the discussion of military history, we
might consider addressing our own issues of countertransference. This issue