282 Grief and Loss Across the Lifespan
who practiced for over 15 years in a rehabilitation hospital as a discharge planner
and then as an administrator. She is currently an associate professor at the School
of Social Work at Rutgers University, the State University of New Jersey in New
Brunswick, New Jersey, and the special assistant to the dean for interprofessional
education. She has a Without Compensation (WOC) appointment as a health
science specialist at the Veterans Administration New Jersey Healthcare System
in East Orange, New Jersey, and holds an adjunct faculty appointment with the
Uniformed Services University for the Health Sciences in Bethesda, Maryland.
She has authored numerous peer-reviewed articles and book chapters, and has co-
authored the book, The Cancer Survivor’s Guide: The Essential Handbook to
Life After Cancer, with Michael Feuerstein, PhD, MPH.BackgroundIn 2010, approximately 40% of veterans were 65 years old or older (Chatterjee,
Spiro, King, King, & Davison, 2009). Nearly 70% of veterans are not seen in
Veteran Administration programs or hospitals meaning that they are receiv-
ing services in general population programs and hospitals. It is important for
all social workers to recognize that those who served in the military may face
challenges due to that military service. I will provide an overview of how loss
and grieving may be conceptualized by a military veteran and then apply
these to Wesley’s case. Although the losses of functioning and relationships
later in life are important points for us to consider, it is important to see these
areas within the context of how the military experience may influence some
military veterans’ perspectives.
The Veterans Administration (VA) has conducted extensive research
over the decades to examine the health care concerns and needs of the aging
veteran population while assessing the impact of military service on health
(Chatterjee et al., 2009). The VA has embraced integrated care through the
concept of the patient-centered medical home and has integrated aging as an
aspect of diversity (Karel, Gatz, & Smyer, 2012). Integrated care allows access
to mental health services within primary care settings. The veteran population
has higher levels of physical and/or mental health symptoms than the typical
civilian aging population (Rubin, Weiss, & Coll, 2012).
The biopsychosocial approach to the care of the aging veteran is a ben-
eficial approach to use, particularly with aging veterans, as this approach
considers the biological, social, psychological, and the environmental
aspects of the individual. This means that the clinician must work collabora-
tively with other providers to ensure comprehensive care. Clinicians need
to be aware of the impact of aging on all of these spheres and then consider
the influence of military culture as an overlay to all of it when working with
veterans. At its most basic level, military culture places weight on discipline
and hierarchy and prioritizes the group over the individual (Munson &
Daley, 2013). It uses specific rituals and symbols to convey important mean-
ings and transitions (Rubin et al., 2012). It also promotes stoicism, deperson-
alization, and adheres to, in the words of General Douglas McArthur, “Duty,
Honor, Country.”