Loneliness and Social Isolation of Military Veterans: Systematic Narrative Review
Abstract: Loneliness and social isolation are being increasingly recognized as influencing both physical and mental health. There is limited research carried out with military veterans and, to date, there is no review of existing evidence. To synthesize and examine the evidence exploring aspects of social isolation and loneliness of military veterans, using a systematic narrative review strategy. A database search was carried out utilizing relevant search criterion. Seven databases were searched for publications with no date restrictions. Articles were included if they involved veterans and either social isolation or loneliness. The initial search returned 484 papers, after exclusions, removal of duplications, and a reference/citation search, 17 papers remained and were included in this review. The retrieved papers examined four areas of loneliness and social isolation: prevalence of loneliness in the veteran population, experiences related to military service as impacting loneliness or social isolation, the relationship between mental health and loneliness or social isolation, and interventions to combat loneliness and social isolation. Differences between the experiences of younger and older veterans were also highlighted. It is evident that military veterans present unique experiences of loneliness and social isolation, especially older veterans. This requires specific attention outside of campaigns targeted at the nonmilitary population.
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.