Military Service and Men's Health Trajectories in Later Life

PARTICIPATION in the military is an often overlooked early-adulthood experience that has the potential to shape a range of later-life health and health-related outcomes (Elder, 1986, 1987; London & Wilmoth, 2006). During the past 25 years, a growing body of research has demonstrated that the U.S. military is a critical social institution that can reshape educational, occupational, income, marital/family, health, and other life course trajectories and outcomes (MacLean & Elder, 2007; Modell & Haggerty, 1991; Settersten, 2006) and that the potential of the military to transform lives varies across individual characteristics, the timing of military service in the life course, service experiences, and historical periods (Angrist, 1990; Angrist & Krueger, 1994; Teachman, 2004; Teachman & Call, 1996). The extant literature on military service and the life course has specifically and primarily addressed the negative impact of military service during World War II (WWII) on the health of men in the general population. This literature indicates that men who entered the military late were more likely to experience health declines throughout life (Elder, Shanahan & Clipp, 1994); exposure to combat predicted physical decline and death during the 15-year post-war interval from 1945 to 1960 (Elder, Shanahan, & Clipp, 1997); overseas active duty, service in the Pacific arena, and combat exposure were related to an increased mortality risk through 2000 (Elder, Clipp, Brown, Martin & Friedman, 2009); and military service caused an increase in work-limiting disabilities for men between the ages of 40 and 60 years and raised the premature death rate between the ages of 45 and 72 years (Bedard & Deschenes, 2006). Using data from the Health and Retirement Study (HRS), London and Wilmoth (2006) report that male veterans have similar or higher mortality in later life than nonveterans, although military service offsets some of the mortality disadvantage experienced by Black men. One recent study indicates that Vietnam veterans had more activity limitations and worse self-rated health than nonveterans, and that, as they aged, functioning and health deteriorated much more rapidly among veterans than among nonveterans (Dobkin & Shabani, 2009). There is also a substantial literature on the physical health of veterans that suggests that veterans are in poorer health and have more functional limitations and disabilities than nonveterans (Aldwin, Levenson, & Spiro, 1994; Beebe, 1975; Centers for Disease Control, 1998; Keehn, 1980; Schnurr, Spiro, & Paris, 2000). Although this literature provides important data on the health of veterans, it often does not directly examine differences between veterans and nonveterans, compare veterans with and without wartime service, or attempt to determine the extent to which service during particular wars has different effects on later-life health. This is problematic given that a large percentage of the older male population in the United States served in the military, often during periods of war. In 2000, almost 9.5 million men aged 65 years and older were veterans, which represents nearly 65% of men in this age group (Federal Interagency Forum on Aging-Related Statistics, 2005). Given that military service is a “hidden variable” in our understanding of aging (Elder & Clipp, 1988; Settersten, 2006; Spiro, Schnurr, & Aldwin, 1994), there is a need for additional research on the effects of veteran status on later-life outcomes. In particular, health research is needed that includes cohorts who came of age during and after WWII, and makes direct comparisons between veterans and nonveterans, between veterans with and without wartime service, and between war veterans who served in different historical periods. In this article, we address the following research questions: (a) Do veterans have different levels and trajectories of health in later life than nonveterans? (b) Among veterans, do those who served during wartime have poorer health outcomes in later life than those who did not serve during wartime? and (c) Among war service veterans, do later-life health trajectories vary across men who served during different wars? We use data from the HRS to estimate growth curve models that test for differences at the mean age of 66.2 years and differing trajectories in the number of health conditions, activities of daily living (ADL) limitations, and self-rated health among men who were born prior to 1955 and came of age from WW II through the Vietnam War. We note that our analyses do not address the experiences of younger cohorts who served after 1973, when the military became an “All-Volunteer Force” and military service became a less normative part of early adulthood.