Wednesday, June 13, 2018

Loneliness: An Epidemic and a High Risk for Veterans

Loneliness: An Epidemic and A High Risk for Veterans

Loneliness has doubled in the U.S. In the 1970’s and 1980’s, Americans who responded that they regularly or frequently felt lonely was between 11 percent and 20 percent (depending on

the study).1 Just a few decades later in 2010, AARP performed a national survey that found that
loneliness had increased to between 40 and 45 percent among adults.2    And in 2017, former
U.S.   Surgeon General Dr. Vivek Murthy called loneliness an “epidemic” and stated that “loneliness shortens lifespans in a way similar to smoking 15 cigarettes / day”.3

The destructive effects of loneliness don’t end there. People who identified themselves as  lonely had a statistically significant 45 percent greater risk of death.4 "People aren’t [technically] dying of loneliness. But they are dying of cardiovascular diseases, cancer, accidents, suicide and diabetes. Based on your genetics and your environmental history, loneliness can make these conditions strike earlier than they otherwise would have," said Dr. John Cacioppo of the
University  of  Chicago’s  Center for Cognitive and Social Neuroscience.5    In fact, according to a
2018 study (by AARP, Stanford University, and Harvard University), Medicare spends $6.7 billion more annually on socially isolated older adults compared to adults that are not isolated.6

Isolated Veterans living at home have a high risk of feeling loneliness, so it’s that much more important to identify the warning signs that your loved one is feeling lonely.

Signs of Loneliness 

Here are some of the signs to look for so that you can seek help:

1.       Poor Sleep. Individuals who are suffering from loneliness often have poor sleep. According to Dr. John Cacioppo, "A handful of studies have shown that when you’re lonely, your brain remains alert for threats and you show more micro awakenings or sleep fragmentation. This has an adaptive purpose: If you’re isolated, you could be predated at any moment. It doesn’t matter whether you are sleeping next to someone—if you feel isolated, that causes the brain to remain on alert."7

2.       Frequent Sickness. Individuals that are lonely are more likely to get sick. Dr. Cacioppo stated, “We’ve found loneliness is associated with altered gene-expression, which makes you more susceptible to viruses, a correlation that has been shown in humans and animals.”8

3 See

3.       Longer, Hotter Showers. Studies indicate that lonely people take longer and hotter showers--the lonelier the person, the longer the shower and the hotter the preferred temperature. According to Dr. John Bargh, Professor of Psychology at Yale University and administrator at Yale's Automaticity in Cognition, Motivation, and Evaluation (ACME) Lab, "[P]eople tend to self-regulate their feelings of social warmth through applications of physical warmth, apparently without explicit awareness of doing so."9

4.       Buying More Stuff. Individuals that are feeling lonely may look to fill a void through more consumer spending. According to a study conducted by Dr. John Lastovicka of Arizona State, "We...find that material possession love is empirically tied to loneliness and social affiliation deficits, which suggests a compensatory basis of consumer well-being."10

5.       Having Friends Who Are Lonely. Loneliness can be contagious. According  to research published in the Journal of Personality and Social Psychology, individuals are "more likely to be lonely if a person they are directly connected to (at one degree of
separation) is lonely."11      Dr.  Cacioppo  theorizes  that loneliness is passed on through
negativity and lack of trust. "People who feel lonely view the social world as more threatening," he says. "They may not be aware they are doing it, but lonely individuals think negatively about other people. So if you are my friend, and I started to treat you negatively, then over time, we would stop being friends. But in the meantime, our interactions caused you to treat other people less positively, so you're likely to lose friends, and they in turn are likely to lose friends. That appears to be the means of
transmission for loneliness."12    Negative feelings can be passed on by people when they
frown or make unpleasant facial expressions, make negative comments, or even use anti-social body language.
 Ways to Overcome Loneliness

 Where caregivers of Veterans are actively trying to help, often Veterans are still isolated for long periods of time and may still struggle with loneliness. Still, there are ways to combat isolation and loneliness:

1.       Have a Purpose. Regardless of whether Veterans live alone, they can still have a purpose. Even with advancing age, there is a world of opportunity for Veterans to  identify a purpose for their lives. Veterans can record their personal and family history, learn a musical instrument, or start reading that volume of books about World War II that they’ve always wanted to.

10 See

One exciting way of having a purpose for seniors is starting a “Bucket List.” What have you dreamed of doing in this life? Where have you dreamed of traveling? Whether the answer to those questions is whale watching, eating a new food like calamari, or finally reading “War and Peace,” anything is possible.

Psychotherapist and author Ross Rosenberg recommends to those wanting to overcome loneliness: "Open yourself up, take risks, and allow yourself to be vulnerable. Since loneliness results in isolation, experiment by sharing aspects of yourself, including experiences, feelings, memories, dreams, desires, etc. This will help you feel more known and understood."13

2.       Get Involved. Veterans who are isolated are at greater risk of loneliness. "There's no hard-and-fast rule that everyone needs to be involved with others all the time, but we tend to feel better when we're with others, and we may feel worse if we're often alone," says Dr. Michael Craig Miller, a Harvard Medical School assistant professor of psychiatry.14

There are many ways to get involved in your community. From joining a club (e.g., bridge club, mahjong club, jazz club, etc.) to volunteering (e.g., helping provide information at a local shopping mall, delivering Meals On Wheels, becoming a mentor, tutoring, etc.), there are lots of ways to get involved. Most cities have local resources available for Veterans that has a calendar of events (e.g., women’s events, hikes, golf events, holiday ceremonies, encampments, job fairs, benefit open houses, gun shows, etc.).

If Veterans prefer to stay at home or have mobility limitations, there are more and more resources available online, including online book clubs, online family history, online games (e.g., chess, Scrabble, fantasy sports, etc.) and online classes (e.g., learning a musical instrument, cooking, dance, gardening, mechanics, learning a new language, lectures and podcasts, etc.).

"When you're alone, you focus too much on yourself and dwell on regrets or worries. When you're with other people, you turn your focus outward. When you're thinking less about yourself, you're worrying less about yourself," says Dr. Miller.15

3.       Take Advantage of New Technology. For decades aging Veterans have had very limited options for companionship while living at home, other than family or caregivers. A new company, Veras (, provides a cheaper and easier alternative. Veras provides senior home care via video calling and allows aging Veterans to stay in the place they most love--their homes.

Veras leverages simple video calling technology (similar to Skype or FaceTime) to pair aging seniors one-on-one with Veras Remote Companions to provide companionship and personal assistance. Veras Remote Companions provide medication reminders, schedule doctor appointments, play games, and provide companionship through conversation. Veras Remote Companions also help family members stay in the loop by sending weekly email reports about activities (Watch video at

Thankfully there is growing awareness around the problem of loneliness, and, where we all make efforts to help those around us, we can make a difference.

Ben Zimmer

Tuesday, January 23, 2018

Suicide Prevention: Helping Yourself and Others Step Away From the Ledge

Suicide Prevention: Helping Yourself and Others Step Back from the Ledge

Photo courtesy of Pixabay by PublicCo

By Jennifer Scott,

Chris Cornell. Robin Williams. Chester Bennington. What do all these names have in common? They all dealt with various addiction and substance abuse struggles. They all struggled with suicidal thoughts. And, ultimately, they all took their own lives.

There’s been a 40% increase in the suicide rate in the last decade. Nearly 80% of those who commit suicide are male. Suicide is one of the leading causes of death, and is expected to overtake cancer deaths within the next 15 years. In fact, one person commits suicide every 15 minutes.

Some argue that suicide has become an epidemic in our society - with someone taking their own life every fifteen minutes. This has led to comparisons between the suicide epidemic and the cancer epidemic, with suicide and depression estimated to overtake cancer as one of the leading causes of death in the next 15 years. Russell Brand has even theorized that cultural changes in the developed world have led to an increase in the number of suicides each year.

It sometimes feels like there’s a new report of someone committing suicide on the news each week. For those who are struggling with depression, substance abuse, or suicidal thoughts, it can feel like the world is bleak and that there is no hope to be found. Nothing could be further from the truth.

There’s an unspeakable amount of grief and disbelief when we lose someone to suicide. Suicidal thoughts can happen to anyone, but that doesn’t mean we’re without hope. Luckily, there are some things you can do to help yourself and/or your loved ones:

Here are some things you can do:

Reduce the Stigma
Talk about mental illness, depression and suicide in the same way that you would talk about diseases like cancer. Spread awareness. Help share resources, crisis hotline numbers and prevention strategies. Avoid criticisms, name-calling, casting blame or showing judgment. You never know what someone else was secretly dealing with. Mental health conditions are every bit as serious as physical conditions like cancer, and should be treated as such.

Emergency Resources
If you or a loved one are dealing with suicidal thoughts, it can be immediately beneficial to talk to someone for help. Not only does this let you know you’re not alone; it can also provide coping mechanisms to help get through your current situation. There are many nonprofits and resources available to assist those in need. Here’s a list of suicide prevention & crisis hotlines available around the world.

Long-term Prevention Strategies
Even if you’re not currently in crisis, it is helpful to have a longer term strategy in case suicidal thoughts ever return. Prioritize your mental health care and make lifestyle changes to assist you in coping with your depression during difficult times. This might include surrounding yourself with positive, supportive people; being aware of the suicide prevention resources listed above; becoming more involved in your local church or faith-based organization; kicking an addiction or substance abuse issue; or even picking up a healthy habit such as yoga or meditation.

Losing even one person to suicide each year is losing too many. Suicides are preventable. Please use and share the crisis resources and suicide prevention strategies listed above. You never know whose life they might save - possibly even your own.

Jennifer Scott

Thursday, March 2, 2017

VA Caregiver Program Changes & Awareness Recommendations

Points of new awareness about the VA Caregiver Program:

Please be certain to research beyond private, secret, and open Caregiver Communities on social media.  Rumors can spread like wildfire, even when the information is not accurate.  Rising anxiety levels within the family rarely does anyone good.  Find out the facts first.  Note that VeteranCaregiver goes directly to the VA Central Office with questions raised on specific processes, caregiver law, and changes.  The answers are not always clear and often raise more questions -- but these are direct responses from Caregiver Program Leadership.  

Something one Caregiver Support Coordinator tells you does not always confirm national guidance.  Each VISN has the flexibility to implement the program (*within the parameters of the Caregiver law*) differently.  We already posted the official response to new phrases used in 2016 regarding “short-term recovery program”, “graduation”, and the significant reductions in Tier 3 caregiving.  According to the VA, there are no quotas, no changes in eligibility requirements, and no changes in ADL measurement. Note possible discrepancies to the law, with date, person, VAMC, requests for clarification in writing and attach a Read Receipt to the short message.

ADL’s still form the basis for eligibility, as do safety and protection elements.  Here is an excellent example of the detail you may need to explain about only a single ADL:  bathing independently.  See below and other questions and responses may be found on’s website in the “Ask Questions Here” section on the Homepage:

This is a great example of when detail explains what the needs are. If you haven’t already, write all this down, since if the questions are not asked about detail, then assumptions are made. What you describe fits the definition of needing assistance with bathing, but if the right questions aren’t asked, or the vet glosses over his not wanting to say personal details, there is a chance that this will be overlooked. Write this up and ask that the evaluator/RN/PCM add it to his medical records.

If you need to appeal a VA decision, you will need to know the precise reasons to address points specifically in your appeals documentation.  Appeal justification is best explained using language similar to the clinical language provided to you as the reasons for the caregiver program change in status.  Specific points, evidence, and documentation is best delivered in a succinct document, and excess emotion removed. Abusive language is not advised even if you feel it is warranted.

Appeals timing of document submission will vary from VAMC to VAMC, but will be shared with you upon request.  Also ask specifically for "confirmation of the receipt of the documents for appeal", and again request "confirmation that the Appeals Panel reviewed the materials prior to their decision" in writing.  Note the timing of decision letters and the receipt of documents.

There are separate VA non-medical databases that contain feedback on the caregiver and veteran.  This information may not be available to those reviewing appeals, and request copies of both the Patient Advocate Tracking System (PATS) notes, and any Caregiver Application Tracking System (CATS) notes.  (This may mean a FOIA request.) The noted information may be used for decisions and unless you’ve verified the information is correct, or that information is missing, your status may be adversely affected.  It appears that access to this information varies per VAMC.

The specific reasons for Caregiver Program reduction or termination" will be explained to you in a transparent, understandable manner" per VACO.  It’s best to receive this in writing, and we have seen only a single VA do this in the status change letter.  You may request to record a Skype call if you’re far from the VA and a meeting is offered, and you may request to tape a meeting for an in-person meeting.  We recommend responses in writing so you can review and compare to your veteran’s needs, the responses used for the decision, if records were changed or missing, and to determine your response.

Trust, but verify information.  It is very possible to receive a VA response that is accurate, but literal.  If you don’t receive direct answers to questions, rephrase them politely in an email and request clarification of the response.  It should not be necessary when direct responses and transparency would be more efficient, but ... Make use of an outside advocate (AW2, Legion, AMVETS, etc.) when in doubt.

Please stay informed, use trusted resources and advocates, and know how absolutely vital caregivers are to the care of our nation’s wounded, ill, and injured.  We will continue to post direct VACO Caregiver Program responses to your questions for your increased awareness.

Linda Kreter & the VeteranCaregiver Team

Friday, November 18, 2016

A Tired Caregiver - VA Visits

I happen to enjoy visits to the "big" VA clinic. It gets me out the house and gets us around other people. But -- my husband hates those visits.  He associates doctors with pain, because every visit causes him pain, dread, and fear.

Example:  he hates the dentist and we had to cancel several visits because he just plain refuses to get dressed and leave the house.  He knows he needs to go, but just sees the painful part.  PTSD, anxiety and mental issues make it worse. 
How do other caregivers deal with it when your Veteran refuses visits to the Doctor/VA?  When it’s hours away and turns into an all-day event?  Do you bribe with visits to certain places?  Do you risk them having a meltdown in the VA or wherever they hate to go?  We try to stay in our role as spouse, but it feels like being a mother, or shaming him if we insist.

Why is there no program at the VA for Veterans with Doctor-related anxiety related to enduring pain?  Every visit seems to incur pain and the further apart the visits, the more pain.  If we go to the dermatologist for a mole, that won’t hurt, but do I bring up the infected toe?  Removing part of a nail takes the VA three separate visits!  One to look at it and say "Yes, it’s infected and needs to be removed", the second is the actual surgery to remove the sides of the nail and the third is to look at it two weeks later. 

Each of those visits is a two hour drive -- one way.  Again, why can't they just make it easier for us?  PTSD and anxiety make this very hard.  Can’t this be referred to the big VA for surgery and follow-up locally?  No need to make a ten second visit with a Podiatrist turn into an all day thing.

I hope I can find an easier way to get his care to make his life and mine easier.  The care team doesn’t respond except to tell him to man up.  That doesn’t work because he doesn’t feel they care about him. I’m tired of badgering to do doctor visits; am I the only one who’s made out to be the bad guy in “supporting my vet” for care? 

A Tired Caregiver

Thursday, September 22, 2016

Try NEW Things - With Thought & Planning, It IS Possible! -- Guest Caregiver Post

Many of our Veterans that suffer from PTSD and other mental health issues lose interest in things they once loved and enjoyed doing, or may not do them due to physical limitations. 

The man or woman that once was out hunting, fishing or playing or playing golf now just sits around at home doing nothing and watching TV.  Even a simple family outing seems all but impossible as they cannot handle crowds, noises, long lines and get just plain aggravated by most everything.  My own Veteran is like that. He just sat at home and watched TV.  He wanted to be left alone.

Going through trying out a new medicine turned out to be a disaster and re-adjusting to the old medicine took all summer. This meant sitting on pins and needles for what would happen next.  I paid close attention to what shows he was watching in a back bedroom he was holed up in.  He watched Food Network most of the day.  I also knew that grocery shopping is one of the few things he still enjoyed.  Good!  We could go during low customer times and he can walk as slow as he needs and can take breaks as needed. He likes eating (unfortunately).

But, as a family, we hadn't done a single thing all summer.  School was coming up quickly.  How could I combine groceries, eating and fun for some teenagers into one activity?  Impossible at first glance.  But, in our case, I had paid enough attention during hours and hours of Food Network to remember a place called Jungle Jim's in Ohio.  I suggested going there. As usual, he was worried. He came up with all the things why we couldn't go.  Do they have electric carts?  What if he has a panic attack?  What if his sunglasses break (he needs them to shield his eyes from bright light and they broke 2x before while shopping)?  I did hours of research. I promised to buy gear from his fav college team, and put spare shades in the car.  "Sweetie, they even have a Starbucks and I can buy you an iced coffee", plus we can take breaks as needed.  I mapped all the bathroom breaks, a trip to Skyline Chili AND a bucket of wings from the Lube.  I showed him pictures of the supermarket, how they had food from all over the World and the US.

This last point finally sparked his interest. Normal grocery shopping in a place also fun for our kids and two restaurants he likes. For the first time this summer he had done something new, and with the family.  We were so proud of him.  And of the family…

Even a Veteran that has virtually no interests left (or so it seems) can find things they can do with the family.  I had to pay close attention to mine. It was food for him. For your Veteran, it might be a favorite sports team, books they enjoy, tech gear, art supplies, or movies.  If you find what they still can enjoy, you can find something new to do. Is there a book store they haven't been to? Is there a place where a movie was filmed? (I took our family in better times to where they filmed “A Christmas Story”.) Restaurants they might enjoy? (Calling ahead might be necessary to see if they take out or can provide a quiet place for a Vet with PTSD -- we had to take food out and did a picnic.)

If they fear regular movie theaters try finding a drive-in. This way you can stay in the car in the back row or on the side.   It gives them more security knowing they can get out fast if needed.  See what sparks their interest, be creative. 

Doing new things, even with a great deal of planning helps the whole family.  What has worked for you?

Caregiver Cornelia Malies, Kentucky
Guest Blog Post

Thursday, June 30, 2016


All relationships create opportunities for communications, or no communication, but both words and deeds are powerful and once said or done, very difficult to un-hear and un-see.  Forgiveness is a powerful concept, but one of the most difficult actions and choices to make in life. 

How do you repair or maintain a relationship following harsh or painful words and actions?  Choosing first to repair the schism is important.  And, it may mean a conscious choice to address some painful personal truths.  Many neglect to look inward to closely analyze what may be something you’d rather forget – introspection and bald reality can be difficult to manage.  Yet, if you fail to learn from situations, you are likely doomed to both suppress negative emotions, and to repeat the behavior.

If you received harsh or painful words, it takes a very strong person to look unflinchingly at what occurred and to calmly analyze it before addressing it. It’s easy to immediately lash out verbally in retaliation, especially if the words or actions were unjustified or unfair.

We are all familiar with words said in anger, and despite the nursery rhyme about sticks and stones… some words wound and scar.  Only you can determine the intensity of the exchange and whether forgiveness is an option, but without resolution, you may find yourself bitter, not better.  This decision to repair can be rapid or take years, but it’s worth considering for a calmer, happier life.

Many people cannot or will not deal with conflict.  If you’re one of these, consider how repairing the friendship will affect your life.  Usually, it clears the air, and both people can move forward.  No matter the timeframe, carefully choose accurate, but kinder words to explain how you feel – whether you are the deliverer of the harsh words, or the recipient.  It’s now time to fix the error, not to blame or shame.  This may not be possible on the first try, and you may find that some conversations are not recoverable, and that door must be closed. 

If both people are open to nurturing a relationship after harsh words – which happens to all of us – it is possible to move forward, even without an apology if that occurs.  Respectfully hearing or saying that the situation is now regretted may be enough to begin the healing.  Perhaps the apology is at first a Band-Aid.  But, over time, when forgiveness is applied and the situation is not a repetitive pattern of hurt, relationships can grow stronger than before.

Why is it that as small children we could easily say we were sorry when we knew we were wrong?  Why is it hard sometimes to stand up for ourselves when we have been wronged?  Either scenario is made better with resolution and kindness.

Forgiveness frees and releases the pain and increases self-respect and respect in the relationship.

Linda Kreter & the 
VeteranCaregiver Team

Korean War Veteran Caregivers

All Caregivers matter to us.  And, learning about illnesses and conditions other era caregivers experience helps when meeting another caregiver during a VA appointment or at a veteran event.  Specifically, cold-related injuries and nuclear testing radiation exposure trouble many veterans of this era.

Korean War conditions include some today’s conditions, but the prevalent differences were cold-related injuries.  Frostbite and Trench foot, were major problems during the Korean War.  Veterans of the Battle of the Chosin Reservoir had especially high rates of severe cold injuries, and over 5,000 troops required evacuation for the effects of cold injury during the winter of 1950-51.  Many veterans never sought VA help due to battlefield conditions or because their service medical records may no longer exist. 

Long-term delayed symptoms include peripheral neuropathy (nerve pain), arthritis, foot problems, stiff toes, and cold sensitization.  Age may worsen these conditions, and complications such as diabetes or peripheral vascular disease put them at higher risk for late-in-life amputations.
Photo:  John P. Collins
Many Korean War veterans may have participated in 250 atmospheric and underwater nuclear weapons tests conducted primarily in Nevada and the Pacific Ocean between 1945 and 1962.  These vets are known at A-Vets or Atomic Veterans, and number 560,000 troops. Approximately 195,000 surviving "Atomic-Vets" alive today may not know that their "oath-of-secrecy" tied to their nuclear weapons testing duty has been lifted, allowing them to now speak freely of their personal experiences.  A-Vets may be entitled to "service-connected" benefits for illness caused by their exposure to atomic radiation particles while on active duty, and benefits are also available to spouses of deceased Atomic-Veterans.

The National Association of Atomic Veterans is a strong resource, and please go to the Video Resource section of to have a larger list of resources mailed directly to your inbox.  We appreciate the caregivers of the Korean War and hope that caregivers of every era support one another in whatever ways possible!

Linda Kreter & the
VeteranCaregiver Team