Advancing an understanding of selves in transition: I-positions as an analytical tool
Self-identity work appears to be a challenge for many service members as they transition and reintegrate into civilian life. When other cultural influences seem to threaten an established self as it labors with transition, tension and conflict may arise and can potentially impact mental health. Insights from an ongoing longitudinal project on the subject matter indicate that an analysis of an individual, which utilizes the concept of I-positions may serve as a useful analytical tool during these processes. A longitudinal methodology combining a narrative approach with such an exploration of I-positions derived from a dialogical self framework may prove to be a promising avenue to advance the understanding of selves in transition beyond the dichotomy of the military and civilian spheres. The bridging capacity of I-positions lies partly in the capacity of significant others to link the self to both spheres and to help fill the perceived void between these two realms, which in reality may be overlapping and intertwined. The findings suggest, facilitated by two case study examples, that military transition to civilian life may benefit from a dialogical approach. This dialogical mind-set could even already be introduced and established during basic training. However, there is also a shared responsibility for individuals in civilian contexts to invite former service members into open dialogue just as the service members themselves shall strive to initiate earnest dialogue. Future research is encouraged to widen the methodology and knowledge of selves in transition.
Abstract: Objectives: Increasing numbers of older adults are reentering community following incarceration (i.e., reentry), yet risk of incident neurodegenerative disorders associated with reentry is unknown. Our objective was to determine association between reentry status (reentry vs never-incarcerated) and mild cognitive impairment (MCI) and/or dementia. Methods: This nationwide, longitudinal cohort study used linked Centers for Medicare & Medicaid Services and Veterans Health Administration data. Participants were aged 65 years or older who experienced reentry between October 1, 2012, and December 31, 2018, with no preincarceration MCI/dementia, compared with age-matched/sex-matched never-incarcerated veterans. MCI/dementia was defined by diagnostic codes. Fine-Gray proportional hazards models were used to examine association. Results: This study included 35,520 veterans, mean age of 70 years, and approximately 1% women. The reentry group (N = 5,920) had higher incidence of MCI/dementia compared with the never-incarcerated group (N = 29,600; 10.2% vs 7.2%; fully adjusted hazard ratio [aHR] 1.12; 95% CI 1.00-1.25). On further investigation, reentry was associated with increased risk of dementia with or without prior MCI diagnosis (aHR 1.21; 95% CI 1.06-1.39) but not MCI only. Discussion: Transition from incarceration to community increased risk of neurocognitive diagnosis. Findings indicate health/social services to identify and address significant cognitive deficits on late-life reentry. Limitations include generalizability to nonveterans.