• The World Health Organisation (WHO, 2015) report on ageing and health defines healthy ageing as the process of developing and maintaining the functional ability that enables well-being in older age.
• The purpose of the literature review was to inform the Department of Veterans’ Affairs (DVA) about:
o whether ageing veterans experience challenges and issues that differ from those of the general population;
o factors and interventions that positively affect health and wellbeing outcomes for older people (particularly those from military backgrounds).
• Two broad age groups were specified: 45 to 64 years and 65 to 90 years.
• This literature review was consistent with the WHO definitions of active ageing in focusing on three aspects of wellbeing: physical, mental, and social.
• Eight separate, systematic literature reviews were conducted to explore the following themes.
o Challenges: The physical, mental, and social wellbeing of veterans compared with that of the general population (five reviews). These reviews included studies comparing:
(a) wellbeing outcomes for veterans and nonveterans within the same study, or
(b) veterans with norms on key measures of physical and mental wellbeing.
o Determinants: Determinants of physical wellbeing, mental wellbeing, and social engagement in veterans compared with the general population (two reviews). Studies included in these reviews compared veterans with nonveterans on theoretical determinants of wellbeing outcomes or predictors of wellbeing outcomes.
o Interventions: Interventions to promote healthy ageing in veterans (one review). Studies were included if they were randomised controlled trials, and were omitted if they focused only on post-traumatic stress disorder (PTSD). These studies did not compare veterans with nonveterans.
• The reviews focused on peer-reviewed, quantitative studies identified through searches in Medline. The reviews found, in total:
o 62 studies on challenges to healthy ageing among veterans compared with nonveterans;
o 77 studies on determinants of physical, mental, and social wellbeing among veterans compared with nonveterans; and
o 98 studies on interventions to address physical, mental, and social wellbeing among veterans.
• Each of these studies was assessed for its strength of evidence and its relevance to Australian veterans.
o Some identified studies were subsequently omitted from the summaries of evidence on grounds such as invalid comparison groups or low relevance to Australian veterans.
o Four studies from the Australian grey literature were added to supplement evidence on Australian veterans.
• Key findings of the review included:
o Some veterans clearly experience considerable challenges to healthy and active ageing in comparison to nonveteran peers, including increased risk of poor physical health, poor mental health, and low social engagement. However, the evidence suggests that these hindrances are not experienced equally by all groups of veterans, nor in all domains.
o Determinants of wellbeing outcomes that disadvantage veterans in comparison to nonveteran peers include the experience of traumatic life events and poor health behaviours (higher smoking and alcohol use, poor sleep, and increased risk of obesity), whereas protective factors for veterans include education and the ability to access health care.
o A wide range of intervention types have been attempted to improve the wellbeing of older veterans. The review supported the use of telemedicine/telephone support,
in-home health assessment, and self-management of chronic health conditions.
o Gaps in the literature on veterans that are apparent in the wider literature on ageing and aged care services include: a salutogenic approach to ageing, reablement, consumer-directed care, and use of technology.