Geriatric Psychiatry in the Department of Veterans Affairs: Serving the Needs of Aged and Aging Veterans

T issue of the American Journal of Geriatric Psychiatry includes seven articles from investigators in the Veterans Health Administration, the health system of the U.S. Department of Veterans Affairs (VA). Thearticles speak to thebreadthof expertise andexperience in geriatric psychiatry within the VA, in areas of special concern to Veterans as well as those that are of general importance to the entire population. Two of the articles deal with a specific focus for VA, posttraumatic stress disorder (PTSD) as it occurs in late life.1,2 This is a condition that is more common and more likely to be recognized in VA than in other settings, but it is, by no means, unique either to VA or to Veterans. Knowledge gained from the VA can be of value in guiding the diagnosis, evaluation, and treatment of the condition as it occurs, less frequently, in other settings. Four of the articles report on lessons learned from research on Veterans that are important across populations. Two articles report on issues related to the integration of mental health services with primary care,3,4 reflecting lessons learned during VA’s ongoing national implementation of integrated care programs. One article reports a systemwide look at the treatment of late-life depression,5 an investigation that was facilitated by the availability of VA’s electronic medical record system. One article reports on family caregiving for Veterans with dementia6; it is a product of collaborationbetweenVAandcommunitybased investigators and represents the types of partnerships that are needed to address the needs of Veterans with chronic disease and disability as they live within their families and communities. Finally, one of the articles askswhether the clinical features ofmental health conditions (late-life schizophrenia or schizoaffective disorder) differed between Veterans and other older men.7 The answer is that they do, and that, in important ways, older men with a history of military services may have a more benign course when they experience these conditions in late life. The question about whether Veterans are different from other Americans, even years after their military service, is an important one. Veterans are distinguished by their history of service to their country, their training, and their membership in the unique culture shared by military service members and Veterans, all of which are important strengths. However, they may also experience service-connected and combat-relatedmental health andmedical conditions. In many cases, Veterans view these as challenges to be overcome. However, all too often these conditions lead to suffering and disability. Moreover, they interact with the aging process, affecting Veterans in different ways at different periods in their lives. It is useful to extend the question about differences to askwhether healthcare inVA is different fromother healthcare systems in America. VA has specialized services, and VA providers have extensive experience in addressing service-connected and combat-related conditions that may be uncommon in other settings. Moreover, it provides care for these and other conditions in a way that is sensitive and responsive to military and Veterans culture. Beyond the issues related