The following is a summary of “Factors Associated With Distress Related to Posttraumatic Stress Disorder at the End of Life Among U.S. Veterans,” published in the April 2023 issue of Pain Management by Kaiser, et al.
Posttraumatic stress disorder (PTSD) can manifest or reemerge at the end of life (EOL), leading to increased patient suffering. Identifying factors associated with PTSD at EOL can help clinicians identify high-risk veterans. For a study, researchers sought to determine the rates of PTSD-related distress at EOL and identify variables associated with this distress.
The retrospective observational cohort study included veterans who died within a Veterans Affairs (VA) inpatient setting between October 1, 2009, and September 30, 2018. The Bereaved Family Survey (BFS) was completed by the next-of-kin of the deceased veterans (N = 42,474). The primary outcome assessed was PTSD-related distress at EOL, as reported by the next-of-kin. Predictors of interest included combat exposure, demographic variables, medical and psychiatric comorbidity, primary serious illness, and palliative care support.
The majority of veteran decedents were male (97.7%), non-Hispanic white (77.2%), 65 years or older (80.5%), and without combat exposure (80.1%). Approximately 8.9% of veteran decedents experienced PTSD-related distress at EOL. Adjusted analyses revealed that combat exposure, younger age, male sex, and non-white race were associated with PTSD-related distress at EOL. High medical comorbidity, dementia, and psychiatric comorbidities such as substance use disorder and depression were also associated with PTSD-related distress at EOL. Palliative care consultation and emotional support were associated with a lower likelihood of PTSD-related distress, while pain was associated with a higher likelihood of such distress at EOL.
Screening for trauma and PTSD, effective pain management, and providing palliative care and emotional support at EOL were crucial in reducing PTSD-related distress, especially among at-risk groups such as veterans from racial/ethnic minority backgrounds and those with dementia.