Narratives of chronic pain from armed forces veterans
This PhD thesis explores the experiences of 14 veterans of the UK Armed Forces who live with chronic pain. While there is a wealth of data exploring chronic pain in Armed Forces veterans, the existing literature overwhelmingly views chronic pain through a quantitative lens which does not explore the depth of chronic pain lived experience as a result of this; therefore, it is unclear how veterans live with and manage their chronic pain. Participants' stories of living with chronic pain were collected and analysed using dialogical narrative analysis and the analytical lens of autobiographical time, to detail veterans’ autobiographical stories of living with chronic pain, and how they use these stories to make sense of their pain experience in the context of their identity as a veteran. The analysis identifies that the participants understood and made sense of their chronic pain experience through three distinct storytelling phases. The first of these were stories of the military body, and this situated a career that was marked by physicality and the churn of life within the military institution. The second phase of storytelling was about the stigmatised body. These stories situate the attitudes toward pain and weakness within the military and the consequences of showing that the military body is infallible, which in turn inform stoic attitudes toward pain and personal pain management. The final phases of storytelling were told about the moving body, stories about the moving body were about making sense of a new body with pain, how some movement is avoided, and the consequences of this on identity. And how movement is used to understand, learn, and respond to and from their bodies on any given day. This is the first in-depth qualitative study that explores the lived experiences of veterans with chronic pain. It found that stories about chronic pain were told in the context of military experience and how the culture of the military shapes attitudes toward chronic pain, while movement was a keyway in which participants live with and manage their chronic pain.
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.