Program Profile

An Interdisciplinary Clinic for Former Prisoners of War

Fed Pract. 2020 April;37(4):182-185

Author(s):

Dean L. Kellogg Jr, MD, MS, PhD

Holly Darling, LCSW, LCDC

Bennetta Crawford, LCSW-S

Andres J. Garcia, LCSW-S

Veronica Camacho

Background: The former prisoner of war (FPOW) population is mandated to “receive the highest quality care and benefit services” from the US Department of Veterans Affairs (VA). Each VA medical facility is required to have a special Care and Benefits Team to meet this policy goal.

Methods: In South Texas, 40% of FPOWs had no VA primary care or clinic assignment. In consideration of the commitment of the VA to care for FPOWs, the unique POW-related medical and psychological issues, the geriatric age of many FPOWs, and the surprising number of FPOWs currently not receiving VA care, the South Texas Veterans Health Care System in San Antonio incorporated the concept of geriatric evaluation and management into its cognitive behavioral therapy team to create a specialized interdisciplinary FPOW Clinic. The main purpose of this project was to advise FPOWs of VA benefits and services as well as to facilitate the identification of overlooked conditions with a presumption of service connection, for example, exposure to Agent Orange.

Results: As most FPOWs are aged > 65 years, the FPOW Clinic was designed as an interdisciplinary team similar to that proven successful in geriatric medicine. Overlooked FPOW presumptive conditions were identified for 34% of FPOWs.

Conclusions: FPOW veterans are rapidly dwindling in numbers and may live in rural areas. Consistent with the VA’s desire to adopt novel technological approaches, we propose to modify our FPOW Clinic by adopting telehealth.

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References

1. Henning CA; Congressional Research Service. POWs and MIAs: status and accounting issues. https://fas.org/sgp/crs/natsec/RL33452.pdf. Published June 1, 2006. Accessed March 16, 2020.

2. Klein RE, Wells MR, Somers JM. American Prisoners of War (POWs) and Missing in Action (MIAs). Washington, DC: US Department of Veterans Affairs, Office of Policy, Planning, and Preparedness; 2006.

3. Skelton WP 3rd. American ex-prisoners of war. https://m.vfwilserviceoffice.com/upload/VA%20Report%20on%20Former%20POWs.pdf. Updated April 2002. Accessed March 16, 2020.

4. Creasey H, Sulway MR, Dent O, Broe GA, Jorm A, Tennant C. Is experience as a prisoner of war a risk factor for accelerated age-related illness and disability? J Am Geriatr Soc. 1999;47(1):60-64.

5. Meziab O, Kirby KA, Williams B, Yaffe K, Byers AL, Barnes DE. Prisoner of war status, posttraumatic stress disorder, and dementia in older veterans. Alzheimers Dement. 2014;10(3)(suppl):S236-S241.

6. US Department of Veterans Affairs, Veterans Health Administration. VHA Directive 1650. Special Care and Benefits Teams Evaluating or Treating Former Prisoners of War. https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=7481. Published July 31, 2018. Accessed March 16, 2020.

7. Boult C, Boult LB, Morishita L, Dowd B, Kane RL, Urdangarin CF. A randomized clinical trial of outpatient geriatric evaluation and management. J Am Geriatr Soc. 2001;49(4):351-359.

8. Kellogg, DL Jr. Geriatric Research, Education and Clinical Center (GRECC): former prisoners of war (FPOW) clinic, methods, procedures & training manual. https://www.southtexas.va.gov/grecc/docs/FPOW_toolkit.pdf. Updated January 28, 2015. Accessed March 16, 2020.

Since the beginning of the American Republic, servicemen have been captured and held as prisoners of war (POWs), including > 130,000 in World War II , > 7,100 in the Korean War, > 700 in the Vietnam War, and 37 in Operation Desert Storm and recent conflicts.^1,2Also, > 80 servicewomen have been held during these conflicts.^1-3 Of those living former POWs (FPOWs), almost all are geriatric (aged > 65 years) with a significant portion aged ≥ 85 years.

The physical hardships and psychological stress endured by FPOWs have lifelong deleterious sequelae on health and social functioning.^3-5 The experiences of FPOWs are associated with higher prevalence of chronic diseases and diminished functional performance in later life as demonstrated by a survey of FPOWs from World War II.⁴ The survey assessed health and functional status in a random sample of 101 FPOWs and a group of 107 non-POW combatants from the same military operations. FPOWs reported a higher mean number of somatic symptoms than did non-POWs (7.2 vs 5.4, respectively; P = .002), a higher mean number of diagnosed health conditions (9.4 vs 7.7, respectively; P < .001), and used a greater mean number of medications (4.5 vs 3.4, respectively; P = .001). Among 15 broad categories of diagnoses, differences were found in gastrointestinal disorders (FPOWs 63% vs non-POWs 49%, P = .032), musculoskeletal disorders (FPOWs 76% vs non-POWs 60%, P = .001), and cognitive disorders (FPOWs 31% vs non-POWs 15%, P = .006). FPOWs had a significantly higher proportion of 7 extrapyramidal signs and 6 signs relating to ataxia. On the Instrumental Activities of Daily Living scale, FPOWs were more likely to be impaired than were non-POWs (33% vs 17%, respectively; P = .01). In addition, FPOWs have an increased risk of developing dementia, and this risk is doubled in FPOWs with posttraumatic stress disorder (PTSD) compared with non-FPOWs without PTSD.⁵

These data indicate that FPOW status is associated with increased risk of disability and loss of independence. Federal statutes established the presumption of a relationship between FPOW status and many comorbidities for VA disability determinations in recognition of such data and to overcome lack of medical records during POW confinement and to accord benefit of the doubt where medical science cannot conclusively link disease etiology to FPOW status, to FPOWs.

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