Impact of military service on physical health later in life: a qualitative study of geriatric UK veterans and non-veterans
Abstract: Objectives: Military veterans often experience physical health problems in later life; however, it remains unclear whether these problems are due to military service or are a feature of the ageing process. This study aimed to explore veteran and non-veteran perceptions of the impact of their occupation on their physical well-being later in life. Design: Semi-structured qualitative interviews analysed using thematic analysis. Setting: Interviews were conducted face-to-face in participants' homes or via telephone. Participants: 35 veterans (≥65 years), 25 non-veterans (≥65 years) were recruited, as well as a close companion of all participants for triangulation (n=60). Results: Most veterans reported good physical health later in life which they attributed to the fitness they developed during military service. However, several veterans described challenges in maintaining their desired level of physically activity due to new commitments and limited sports facilities when they left service. Fewer non-veterans had experienced work-related fitness activities or exercise in their civilian jobs. Ongoing physical health difficulties, such as deafness, were perceived to be due to exposure to workplace hazards and appeared more common in veterans compared with non-veterans. Veterans also described greater reluctance than non-veterans to seek medical treatment for physical health difficulties, which could be challenging for close companions who had to provide informal care. Conclusions: Military service was largely perceived to be beneficial for physical well-being; although when occupation-related physical health problems were experienced, many veterans were unwilling to seek treatment. These findings may inform clinicians of the needs of older veterans and highlight potential barriers to care.
Abstract: Novel and automated means of opioid use and relapse risk detection are needed. Unstructured electronic medical record data, including written progress notes, can be mined for clinically relevant information, including the presence of substance use and relapse-critical markers of risk and recovery from opioid use disorder (OUD). In this study, we used natural language processing (NLP) to automate the extraction of opioid relapses, and the timing of these occurrences, from veteran patients' electronic medical record. We then demonstrated the utility of our NLP tool via analysis of pre-/post-COVID-19 opioid relapse trends among veterans with OUD. For this demonstration, we analyzed data from 107,606 veterans OUD enrolled in Veterans Health Administration, comparing a pandemic-exposed cohort (n = 53,803; January 2019-March 2021) to a matched prepandemic cohort (n = 53,803; October 2017-December 2019). The recall of our NLP tool was 75% and our precision was 94%, demonstrating moderate sensitivity and excellent specificity. Using the NLP tool, we found that the odds of opioid relapse postpandemic onset were proportionally higher compared to prepandemic trends, despite patients having fewer mental health encounters from which to derive instances of relapse postpandemic onset. In this research application of the tool, and as hypothesized, we found that opioid relapse risk was elevated postpandemic. The application of NLP Methods: to identify and monitor relapse risk holds promise for future surveillance, risk prevention, and clinical outcome research.