Health and Service Needs of Older Australian Veterans

A guide for GPs and health professionals

As Australia’s veteran population continues to age, understanding and addressing the unique health needs of older veterans (including their spouses and widows/widowers) is increasingly critical. These individuals who served their country in conflicts and peacetime operations can face a range of complex health issues shaped by their military experiences and the ageing process. General Practitioners (GPs) and other healthcare providers must recognise these needs to ensure that older veterans receive comprehensive, personalised care.

Key statistics

• At 30 June 2020, over half of all DVA clients (55%, or over 181, 500 permanent, reserve and ex-serving ADF members and their dependents) were aged 65 years and over (AIHWa, 2024).

These veterans served during the periods of World War 2 (1939-1945), Korean War (1951–1959), Vietnam War (1964–1972) and the Gulf War (1991) or in the peace time ADF.

• In 2017–18, males aged 65–74 years who had ever served in the ADF reported mental and behavioural conditions at a rate of 10 percentage points higher than males aged 65–74 years who had never served in the ADF (27% and 17%, respectively) (ABS 2019 cited by AIHWa, 2024).

1. Physical health issues

Musculoskeletal problems: The physically demanding nature of military service often leads to long-term musculoskeletal issues, including chronic pain, arthritis and ongoing disability. Older veterans frequently report back pain, joint issues and reduced mobility. Management of these conditions may involve pain relief strategies, physical therapy and, in some cases, surgical interventions. Ensuring veterans have access to ongoing rehabilitation services is essential to maintain their quality of life.

Cardiovascular disease: Cardiovascular disease (including hypertension and stroke) is a leading cause of morbidity and mortality among older veterans. GPs should monitor cardiovascular health closely. Managing risk factors, such as hyperlipidaemia and hypertension, is critical.  Veterans may need support with adhering to prescribed medications. They are also likely to benefit from tailored lifestyle advice, including diet and exercise programs that account for any physical limitations they may have.

Respiratory conditions: Veterans may have been exposed to hazardous environments, including smoke, dust and chemicals, during their service, leading to a higher incidence of chronic respiratory conditions like Chronic Obstructive Pulmonary Disease (COPD) and lung cancer. GPs should be vigilant in screening for respiratory issues, particularly in veterans with a history of smoking or environmental exposures. Early intervention and smoking cessation support are critical components of care for older veterans with these conditions.

Hearing loss and tinnitus are common among veterans due to prolonged exposure to loud noises, such as gunfire, explosions and heavy machinery. These issues can significantly impact quality of life, leading to communication difficulties, social isolation and increased risk of cognitive decline. GPs should routinely assess hearing in older veterans and refer them for audiology services when necessary. Hearing aids and other assistive devices can greatly improve their quality of life.

2. Mental health needs

International studies have revealed that older veterans are generally resilient, however a significant minority experience mental health concerns that are associated with poor outcomes (Karel et al., 2014). Key issues are summarised below.

Post-traumatic stress disorder (PTSD): PTSD remains a significant concern among older veterans, even many years after their service. Symptoms such as flashbacks, nightmares and severe anxiety can severely impact daily life. Effective management of PTSD often requires a multidisciplinary approach, including counselling, medication and support from veteran-specific mental health services.

Depression and anxiety: In addition to PTSD, many older veterans struggle with depression and anxiety, often exacerbated by the challenges of aging, such as loss of independence, social isolation and the death of comrades. Regular mental health screenings and referrals to mental health professionals are crucial. Community support programs that encourage social interaction can also help mitigate these issues.

 3. Social and Support Services

Social isolation: Social isolation is a common issue among older veterans, particularly those who live alone or have limited family support. This isolation can exacerbate mental and physical health problems. Community-based programs that provide opportunities for social engagement, such as veteran groups and social clubs, are vital for improving overall well-being.

For more information on the local community supports available to veterans, refer to the DVA website Work and social life programs | Department of Veterans' Affairs (dva.gov.au)

Navigating benefits and entitlements: Many older veterans are entitled to a range of benefits, including healthcare services, pensions and other forms of support. However, navigating these entitlements can be challenging. GPs and support workers can help veterans access the services they need by providing information and assisting with the necessary paperwork. (Older Adults Health Pathways, Care at home or aged care | Department of Veterans' Affairs (dva.gov.au)

Access to care: Many older veterans face barriers to accessing healthcare, including mobility issues, geographical isolation and lack of awareness about available services. Ensuring that veterans are connected with healthcare services, including those specifically designed for veterans, is essential. Telehealth services can play a crucial role in reaching veterans who live in remote areas.

The DVA provides three main services to assist older permanent, reserve and ex-serving ADF members and war widow(er)s to stay in their homes.

Veterans’ Home Care (VHC) services

• What: The VHC program provides in-home care and support services designed to assist those who wish to remain living at home by providing practical help.  Services include domestic assistance, personal care, home and garden maintenance and respite. 

• Eligibility: Those eligible for an assessment are individuals who have a Gold Card or White Card (specific conditions and/or Non-liability Health Care). 

• Assessment: A phone assessment is conducted by the VHC Assessment Agency to determine the level of care needs and if required, services are allocated to the VHC Service Providers.  The Assessment Agency will conduct a review on a six monthly basis. Further information can be obtained by contacting the VHC Assessment Agency on 1300 550 450.

DVA Community Nursing Program

• What: The aim of the Community Nursing Program is to enhance a person’s health outcomes and independence, and to assist them to remain at home for as long as practical. Community nursing services can include medication administration and/or assistance, wound care, personal hygiene, showering and dressing, and palliative care. DVA will fund services delivered by a DVA approved community nursing provider.

• Eligibility: Veteran Gold Card holder OR a Veteran White Card holder with a need for the service to support a condition covered by the person’s White Card.

• Referrals: A written referral for community nursing services must be provided by a GP, treating medical practitioner in a hospital, hospital discharge planner or nurse practitioner specialising in a community nursing field.

Referrals must be sent by the referrer directly to a DVA approved community nursing provider and accepted by the provider prior to services commencing. The panel of approved providers is available on the DVA website. Referrals from a GP or a nurse practitioner are valid for 12 months. Referrals from hospitals are valid for 6 weeks, at which time a new referral from a GP is required.

Refer to the DVA website for more information at: www.dva.gov.au/CN

Rehabilitation Appliances Program (RAP)

• What: RAP provides aids, equipment and home modifications to help veterans and war widow(er)s to be independent and as self-reliant as possible in their own home. RAP also provides customised or personalised aids and equipment for those living in residential aged care. 

• Eligibility: those veterans/war widow(er)s with an assessed clinical need for aids, equipment or a home modification and are a Veteran Gold Card holder OR a Veteran White Card holder for an accepted service-related condition.

• Referrals: GPs may prescribe some items or refer to a suitable medical specialist or allied health provider for further assessment. Prescribing health providers should check the RAP Schedule to ensure they are a suitable prescriber for the item/s. When a person is living in residential aged care most equipment is provided by the aged care home and DVA does not seek to duplicate but if a person has a clinical need for a personalised or customised item prescribers should check the RAP in Residential Care List.  

 Refer to the DVA website: www.dva.gov.au/rap-schedule and www.dva.gov.au/rap-residential-aged-care-list

Residential Aged Care Service

Permanent residential aged care is provided by the Department of Health and Aged Care and is accessed through My Aged Care . An Aged Care Assessment is required to assess eligibility. Identifying as a veteran may increase the range of support services available in the aged care facility.

Veterans will still be able to use their Gold card or White card (for the accepted condition) for

• Ongoing GP, specialist and hospital treatment

• Medications

• DVA transport to attend health appointments and hospital visits

• Allied health services e.g. the patient has diabetic foot ulcers and requires weekly podiatry appointments, but the facility has a podiatrist visit only once every four weeks. The patient can use their Gold or White card for weekly visits as clinically required 

On entering the aged care facility the patient is no longer eligible to participate in a Co-ordinated Veteran Care (CVC) program.

Ex Serving organisations e.g. the RSL or War Widows Guild can be asked to visit the aged care facility 

Refer to the DVA website for more information at Moving into residential aged care | Department of Veterans' Affairs (dva.gov.au) and The veteran’s guide to moving into an aged-care home (dva.gov.au)

Conclusion

The health and service needs of older Australian veterans are diverse and complex, requiring a holistic approach to care. By recognising the unique challenges faced by this population, healthcare providers can offer targeted interventions that improve both the physical and mental health of older veterans. Ensuring access to comprehensive healthcare services, mental health support and community-based programs is crucial for enhancing the quality of life of older veterans.