Caring and Coping: the family perspective on living with limb loss
Abstract: This report presents findings of research into how veterans with limb loss, and their families, live with limb loss. Using Grounded Theory, data has been collected from 72 veterans and family members using unstructured interviews, structured questionnaires and closed question telephone interviews. Findings indicate, firstly, that the central concern of veterans with limb loss, and families, is coping during living with limb loss, and that the veteran with limb loss and their carer/s may experience differing levels of coping (low, mid, high) during any specific time period. Each coping level is characterised by behaviours/characteristics to which appropriate support can be aligned; secondly, there are distinct time periods where certain types of Blesma/organisational support are more likely to effectively support coping ability. This report presents these findings, which are developed into a practical Living with Limb Loss Support Model (LLSM). The LLSM identifies specific periods where timely support is more likely to be relevant and effective in supporting individual needs and coping levels, as further explained in the ‘Practical Application of Findings’.
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.