Chapter 18 Private and Government Healthcare Systems Pri

Chapter 18
Private and Government Healthcare Systems
Private and Government Healthcare Systems
In the United States, health insurance coverage is generally
classified as either private (non-government) coverage or
government-sponsored coverage.
Healthcare Coverage vs. Uninsured
The National Center for Health Statistics defines health
insurance as public and private payers who cover medical
expenditures incurred by a defined population in a variety of
settings.
In the United States, the risk of becoming uninsured increases
significantly for those earning low wages, the unemployed, and
when employers are unable to provide insurance to workers.
Table 5-2 presents the trend of declining health insurance
coverage.
Private Health Insurance
The concept of insurance is to combine the healthcare
experiences of many enrollees in order to reduce expenses for
any one individual to a manageable prepayment amount.
Employment-Based Plans is coverage offered through one’s own
employment or a relative’s employment.
It may be offered by an employer or by a union.

Private Health Insurance Continued
Direct-Purchase/Fee-For-Service Plans are the traditional type
of healthcare policy.
The physician sets a price for each type of service delivered,
and then the client or insurance company pays the fee.
This type of health insurance provides the most choices of
doctors and hospitals.
The two kinds of fee-for-service coverage are basic and major
medical.
Basic covers some hospital services and supplies, such as X-
rays and prescribed medicine.
Major medical insurance covers the cost of long-term, high-cost
illnesses or injuries plus whatever basic did not cover.
Group Contract Insurance—to make hospitals and physicians
products and services affordable to ordinary people in the
United States.
With unmanaged care (fee-for-service) payments, healthcare
providers could increase the number of single services they
deliver in order to increase profit.
Managed Care—manages the cost and delivery of healthcare
services, the quality of that healthcare, and access to care.
Managed care influences how much healthcare clients can use.
Health Maintenance Organizations (HMOs) are prepaid health
plans.
The goal of an HMO is to provide affordable, well-organized
healthcare by allowing clients to prepay (capitation payment) on

a regular monthly basis for all services provided.
Including physicians’ visits, hospital stays emergency care,
surgery, laboratory (lab) tests, X-rays, and therapy for all
members and their families.
There may be a small co-payment for each office visit, such as
$15 for a doctor’s visit or $50 for hospital emergency room
treatment.
Point-of-Service Plans (POS) offer enrollees the option of
receiving services from participating or nonparticipating
providers.
The primary care physicians in a POS plan usually make
referrals to other providers in the plan.
If the physician makes a referral out of the network, the plan
pays all or most of the bill.
If the client refers him or herself to a provider outside the
network the co-payment and deductibles would increase.
Preferred Provider Organizations (PPOs) are a combination of
traditional fee-for-service and an HMO.
A PPO requires that the clients choose a primary care physician
to monitor their healthcare.
If the client decides to choose a physician that is not part of the
plan, the client will pay a larger portion of the bill.
If the client’s physician is not a part of the network, he or she
will not be required to change physicians to join a PPO.
Government Health Insurance/

Public Insurance
Government health insurance includes plans funded by
governments at the federal, state, or local level.
The federal agency Centers for Medicare and Medicaid Services
(CMS) administers the programs.
The Medicare Program—Title XVIII of the Social Security Act
is the designated health insurance for the aged and disabled.
Public Insurance Continued
Medicare consists of two parts:
Hospital Insurance (HI), also known as Part A
Supplementary Medical Insurance (SMI), known as Part B
Part C, sometimes known as the Medicare Advantage program,
was established as the Medicare+Choice program.
Part D, a prescription drug benefit that became available in
2004
Part A Coverage is provided automatically and is free of
premiums to persons age 65 or over who are eligible for Social
Security or Railroad Retirement benefits.
Provided to insured workers with ESRD (and to insured
workers’ spouses and children with ESRD), and ineligibl e aged
and disabled beneficiaries who voluntarily paid a monthly
premium for their coverage.
Part B Coverage covers physicians’ and surgeons’ services,
chiropractors, podiatrists, dentists, and optometrists.
Covers services provided by Medicare-approved practitioners

such as:
Dietitians
Certified registered nurse anesthetists, clinical psychologists
Clinical social workers (other than in a hospital)
Physician assistants, and nurse practitioners and clinical nurse
specialists
Coverage Gaps include:
Medicare deductibles
Co-payments
Excess charges by doctors who do not accept Medicare
assignments
Medical services and supplies that Medicare do not cover
Medigap provides extra protection beyond Medicare.
Medigap is a type of private insurance coverage that may be
purchased by an individual enrolled in Medicare.
Part D provides subsidized access to prescription drug insurance
coverage upon payment of a premium individuals entitled to
Part A or Part B.
The Medicaid Program is the largest source of funding for
medical and health-related services for poor people.
Within broad national guidelines each state must:
establish its own eligibility standards
determine the type, amount, duration, and scope of services
set the rate of payment for services

administer the program
Basis of Eligibility—individuals are usually eligible for
Medicaid if they:
meet the requirements for the AFDC
are less than 6 years of age with family income at or below 133
percent
are pregnant women with family income below 133 percent of
the FPL
are Supplemental Security Income (SSI) recipients, etc.
Personal Responsibility and Work Opportunity Reconciliation
Act (PRWORA)—known as “welfare reform” bill.
Welfare reform repealed the open-ended federal entitlement
program known as Aid to Families with Dependent Children
(AFDC) and replaced it with Temporary Assistance for Needy
Families (TANF).
TANF limits a family’s lifetime cash welfare benefits to a
maximum of 5 years.
State Children’s Health Insurance Program (SCHIP) covers
individuals who have incomes too high to qualify for state
medical assistance but cannot obtain private insurance.
Those who can qualify are:
children in low-income families
eligible children under the age of 19 whose state provides 12
months of continuous Medicaid coverage

Medicaid, Title XIX of the Social Security Act offers medical
assistance for certain basic services to most categorically needy
populations.
Box 5-1 presents services generally provided by the state
Medicaid programs.
Balanced Budget Act includes a state option known as Programs
of All-inclusive Care for the Elderly (PACE).
The PACE team offers and manages all health, medical, and
social services.
Successful Community Strategies
The Illinois Department of Human Services integrated WIC wi th
two state-funded programs:
Family Case Management (FCM) and Targeted Intensive
Prenatal Case Management (TIPCM)
Integration of these programs allowed them to operate more
efficiently.
For example, staff members of many local health departments
were trained to provide both WIC and FCM services.
Topics for Discussion
How does poverty limit access to healthcare?
What is the difference between Aid to Families with Dependent

Children (AFDC) and Temporary Assistance for Needy Families
(TANF)?
Who does SCHIP cover?
What is the difference between Medicare and Medicaid?
transitional needs
21
Assessing a Peer's Paper
Peer review is the evaluation of work by one or more people of
similar competence to the person authoring the work (peers). It
is a collaborative process that provides support, encouragement,
ideas, and reminders. We will be using peer review as a
professional process to maintain quality of our final documents
and to improve our writing skills. It is always good to have a
second set of eyes and perspectives to improve the quality of a
body of work. Share your papers on Day 3, and return comments
of at least 700 words by Day 7.
Following are tips to effectively critique your peer's paper.
1. Review the final paper rubrics
2. Be specific in your comments. The following website
provides examples on how to write specific comments that help
guide the writer to strengthen his or her paper:
http://abacus.bates.edu/~ganderso/biology/resources/writing/HT
Wcritique.html
3. Point out the strengths of the paper by noting specific
passages that are well written.
4. Point out where a specific area can be strengthened and in
what way.
5. Take notice of large issues such as:
a. Is the assignment being addressed?
b. Is the main point clear and interesting?
c. Is there a clear focus or thesis?

d. Is the draft organized, following the outline provided in
Week 6, and does it follow a logical sequence of points?
e. Are main ideas adequately developed?
6. Check basic writing skills such as grammar, spelling,
incomplete sentences, over-run sentences, word choice,
confusing sentences, etc.
7. Time is limited, so focus on areas that will give the peer the
most benefit to improve the paper.PEER’S PAPER: SEE THE
BELOW ATTACHMENT
Transitional Needs of Female Veterans: Cultural & Health
Factors
Transitional Needs of Female Veterans: Cultural & Health
Factors
In the United States, as of 2018, 18 million people identify as
veterans (United States Census Bureau, 2018). As of 2010, the
Census Bureau no longer asks the question of veteran status,
whether that is Active Duty, National Guard, or Reserves, via
the decennial census. The new method uses three national
surveys; the American Community Survey (ACS), Current
Population Survey (CPS), and the Survey of Income and
Program Participation (SIPP) (United States Census Bureau,
2017). The demographic information provides insight into how
the total ration of veterans in the U.S. population is shifting.
The demographics of the veterans' population has changed since
military service evolved from a conscripted military to an all -

volunteer force in 1973. Since 1973, the number of veterans
has dropped, with the current level of veterans estimated to drop
by 40% from the current amount by 2045 (Bialik, 2017). The
segment of the veteran population that are women will likely
increase as previous generations of veterans that were
conscripted before 1973 were predominately male.
Currently, as of January 1, 2020, of the United States Air
Force's 328,255 active-duty personnel, 20.9% are listed as
women (Air Force Personnel Center, 2020). Comparatively, in
F.Y. 1994, of the 426,327 Air Force active-duty personnel, just
66,314 (15.5%) were listed as female (Assistant Secretary of the
Air Force, 2000). While the increase of 5% over 26 years may
not overtly be a significant percentile change, the numbers are
moving slowly towards the representation of females in the
overall U.S. workforce, which is significantly more equal.
The tools the U.S. military uses in the 21st to rage war have
changed compared to prior wars and missions. With the advent
of precision-guided weapons, drone technology, space
technology, and digital warfare, there has been reduced use of
ground forces employed compared to prior wars and campaigns.
The number of military members currently serving may incur
less direct combat exposure, compared to previous veterans of
WWII, Korea, and Vietnam. For female veterans that were,
until 2016, excluded from serving in the ground force combat
units, their exposure to direct combat may be higher than in
previous generations. Though, the significance of exclusion
from specific jobs historically and the cultural image of who are
combat soldiers may reinforce gender barriers and career
progression.
To understand veterans and specifically female veterans and
what services are needed after leaving the military, a
background of the cultural differences between life in the
military and life in the civilian should be acknowledged. The
experiences of veterans may vary widely based on several
factors to include: sex, race, the branch of service, officer or
enlisted, length of service, exposure to combat, retired versus

separated, and relative time spent separated from the civilian
market. Many community organizations seek to help members
find an identity after military service.
Veterans Service Organizations (VSOs) are nonprofit
organizations that seek to improve veterans’ quality of life,
through connection, support, and representation in government
(Harada & Pourat, 2004). Having a voice in government for
veterans is essential as the ratio of members in Congress who
have prior military experience has dropped from a high in 1975
of 81% of senators to currently 20% (Bialik, 2017).
Additionally, VSOs can provide military veterans with
organizational structure and peer-level social support (Russell
& Russell, 2018). This may improve a veteran’s mental well -
being based on their military training, experience, and culture,
where individuals rely on each other in life and death situations
(Burnett & Segoria, 2009). For many people transitioning to
the civilian world after military service, VSOs may bridge the
“gap” between these two cultures. How women utilize VSOs is
essential, especially if they feel socially isolated or excluded
while in the military. Joining another military-based
organization after leaving the military may not appeal to
everyone, which adds additional barriers for a member to
receive assistance and care.
The research focus of my paper will center on the issues
surrounding the need for woman's support through the transition
from the military to the civilian world. Women play a more
significant and dynamic role in the Armed Forces. Military
leaders, Veterans Affairs, and VSOs need to develop an
understanding of unique health and transition issues women face
during and after military service.
Literature Review
The literature review provides an overview of the differences
between military service and the civilian sector. Differences
between how family and employment cultural norms impact on
women in the Armed Forces. The information highlights
previous research on cultural differences, documented

challenges of the transition, and VSO functions. The
development of background information will provide context to
view the issues faced by female veterans when they leave
military service.
There are cultural differences between people serving in the
military and the larger population of the United States. Since
1973, the United States military has been an all-volunteer force,
and people join for a variety of reasons. A study by Kelty,
Kleykamp, and Segal (2010), highlights how changing to a
voluntary force meant that military service is no longer a pause
in the pursuit of adulthood. People may choose to enlist for
training, skills, or educational benefits, or a call to service, with
no intention of making the military a career but more of a
stepping stone to future goals (Kelty et al., 2010). All military
forces have some type of basic training required for members
after they enlist into the Armed Forces. These training
platforms can vary in length based on each military branch and
the job the member has assigned. The training seeks to provide
demanding socialization to military customs and standards and
provides a means to facilitate economic independence from
parents (Kelty et al., 2010). But with the positives of obtaining
new skills and opportunities, there are always drawbacks.
While there are benefits to making the transition into military
service, stressors in the military environment may expose
personal vulnerabilities of recruits. Emotional difficulties were
found to be higher in young women, and they demonstrate d the
lowest levels of adjustment to military life (Scharf, Mayseless,
& Kivenson-Baron, 2011). Concepts of hyper-masculinity and
being a warrior at all times in military training further leads to
any idea of weakness as a negative (Burnett & Segoria, 2009).
Feminine qualities and characteristics are devalued in military
culture and have led to more women departing the military or
being subjected to harassment and violence (Kelty et al., 2010).
These characteristics of what makes a good soldier historically
may be at odds in a 21st-century military with an increase in the
number of women joining the ranks. Military service before

volunteer service was not connected with family life, a fact that
dramatically changed after 1973.
A study by Clever & Segal (2013) found that military members
are more career-oriented and family-oriented, so to increase
military member retention, policymakers must ensure the
military family members are happy and supported. The junior
enlisted members are twice as likely to be married compared to
their civilian counterparts and typically have more conservative
values regarding family and gender roles (Clever & Segal,
2013). While roughly 85% of the military is still male-
dominated, the dominant role of childrearing is expected of
women serving, which may hamper their ability to balance roles
(Clever & Segal, 2013). Family-friendly policies implemented
by the military may promote incentives to help male more than
female service members remain on active-duty while taking care
of a family (Lemmon, Whyman, & Teachman, 2009). With a
military designed around marrying young and providing housing
and income benefits, the reinforcement of traditional gender
roles and increased issues of gender bias and discrimination
may incur. For those families of military members, the spouse
and children may find the transition to civilian life equally
tricky.
Military spouses forgo career advancements due to moving
with an active-duty military member. Employment challenges,
frequent moves, unemployment, negative stereotypes, or
oversaturated job markets are shown to put military spouses at a
disadvantage to their civilian counterparts (Clever & Segal,
2013). Frequent moves, deployments, and the effects of
changing parental roles and household norms in military houses
can affect military children (Cole, 2017). A study by Cole
(2017) found that a military student may transition between
schools between six and nine times, which is three times the
number of average for a child of a civilian family. The unique
challenges of the military family as an integral part of the
military structure and the military member’s life may affect the
transition difficulties from military to civilian life once military

service ends.
The transition “gap” when a member migrates from military
service to civilian life is challenging for the member and their
family. A study by Robertson & Brott (2013) showed that post-
9/11 veterans have higher unemployment than the national
average. The translation of military experience to the civilian
market and veterans’ perception of career transition may require
different approaches for men and women (Robertson & Brott,
2013). Designing strategies to move military members to the
civilian sector as smooth as possible can be hampered by both
physical and mental wounds the members carry through the
transition.
Females in the military and women veterans (WV) are more
likely to report mental health concerns, and women in one study
cited a lack of support and cohesion as main contributors
(Thomas, McDaniel, Haring, Albright, & Fletcher, 2018). A
lack of support from institutions after leaving the military has
been linked to increased levels of alienation and feeling
mistreated and unappreciated (Ahern, Worthen, Masters,
Lippman, Ozer, & Moos, 2015). Stress-related disorders in
veterans are as high as one in six members, and most never seek
care. This is based on the stigmas of seeking care, lack of
knowledge, feeling of alienation, and trust (Russell & Russell,
2018). These mental health concerns may lead to higher levels
of homelessness in veterans.
A study by Gordon, Haas, Luther, Hilton, & Goldstein (2010)
found that the nature and stability of homeless living
arrangements have an impact on the medical care of veterans. A
significant amount of homeless veterans were found suffering
from medical and psychiatric disorders (Gordon et al., 2010).
These issues are further increased in women veterans who suffer
higher-rates of trauma exposure across a lifetime and face
additional barriers over their male counterparts to receive
treatment and support (Evans, Glover, Washington, & Hamilton,
2018). The need to understand the obstacles that cause
increased resistance to a successful long-term transition may

improve female veterans' success in managing life after the
military.
Veterans Service Organizations (VSOs) help ease the transition
from the military and provides continued services to veterans
after military service. A study by Russell & Russell (2018)
found that VSOs can serve an essential role in the transition
process and help new veterans retain social identity. VSOs can
provide informal peer-support as part of a person's social
support system that can provide emotional benefits (Russell &
Russell, 2018). VSOs have been well-known for their political
and social support of military members and veterans. A study
by Harada & Pourat (2004) found that VSO members had the
following attributes; above 60 years old, male, Caucasian,
retired, lower-income, had health limitations. The study further
found that VSOs play a significant role in veterans seeking
Veterans Affairs (V.A.) healthcare (Harada & Pourat, 2004).
One nonprofit organization seeking to support both the military
and veterans through a variety of services is the United Ser vice
Organizations.
The United Service Organizations (USO) is a nonprofit
organization founded in 1941 with pressure from President
Franklin D. Roosevelt to combine several service associations
and benefits the community of the United States Armed Forces,
both domestically and aboard. The USO currently has over 230
locations worldwide, and in 2017 more than seven million visits
by military members were recorded (United Service
Organizations, n.d.). Initially, the organization provided USO
centers near bases that would make entertainment and activities
available for military members as its primary purpose
(Fundinguniverse, n.d.). Following WWII, the USO was
reconstructed to provide support for military members at war
and during peace to help both veterans and active duty negotiate
between civilian and military life (Fundinguniverse, n.d.). A
program that started in 2017 was the USO Pathfinder transition
services. The program took two years of development
(Hrcv.uso.org, 2017). The eight main focus areas of the

transition program for service members and their families
include employment, education, V.A. benefits, housing, finance,
legal, family support, and health and wellness (Hrcv.uso.org,
n.d.). The program assists transitioning service members 12
months before and 12 months after separation from the Armed
Forces (Hrcv.uso.org, 2017). The USO transition program
seems to align with the three most cited issues that are recorded
by VSOs to help veterans with. These issues include housing
issues, disability pay and benefits, and employment issues
(Jahnke, Haddock, Carlos Poston, & Jitnarin, 2014). The USO
is a historic VSO like the American Legion and the Veterans of
Foreign Wars (VFW). How these VSOs are aligning to the
changing active-duty and veteran demographics and needs must
be further reviewed.
A study by Evan et al. (2018) found that stress, traditional
gender roles, lack of support for women veterans, and the lack
of female veteran role models demonstrate a need for the
creation of a women veteran's network to increase access to
health and social services. Networking, as part of a new
paradigm for veterans care, was also cited by Cole (2017) in
regards to school counselors and their interaction with VSOs
and other veteran stakeholders. The development of new and
adapted VSOs to reach a broader audience of veterans,
especially when veterans are from disenfranchised groups, may
increase veteran participation.
Gender Differences in Military Cultural and Social Experiences
Since 1973, the proportion of women serving in the military has
grown from 2% of the enlisted force and 8% of the officer corps
to 16% and 18% respectively in 2016 (Council on Foreign
Relations, 2016). This is quite different than the civilian labor
market. According to the Department of Labor (2020) of women
aged 25-54, 77% participate in the labor force. Additionally,
since 2016, women have been authorized into prior male-only
ground combat jobs, with nearly 3,000 women currently serving
in these roles (Addario, 2019). The effects of higher-levels of
inclusion into the military and the relaxation of once male-only

jobs are positive signs towards greater gender openness. There
are real-world implications of how policy implementation may
be hampered by individuals within the structure that explicitly
and implicitly are opposed to gender inclusion.
Figure 1. Population Representation in the Military Services.
Council on Foreign Relations (2016).
Military women are five times more likely to be married to
another service member compared to military men, three times
more likely to be single parents, and women have a higher
divorce rate (Segal, Smith, Segal, & Canuso, 2016). Compared
to white females, black female service members are more
educated and have significantly higher rates of intermarriage
than their civilian counterparts (Houseworth & Grayson, 2019).
These figures point to a military community that may, on paper,
look like it supports working military women. The reality is
leaders may still see military men as the provider and associate
the women as the caregiver, as many military women are still
expected to perform larger amounts of family care than their
military spouse.
Gender norms in the United States associate women as primary
caregivers. The competition of time and mental resources spilt
between family life and military life may be contributing factors
to women leaving the military early (Dodds & Kiernan, 2019).
The reinforcement of gender roles and expectations in a
conservative-leaning military community increases the
likelihood to exacerbate alienation and exclusion.
Issues like benevolent sexism, inappropriate behavior, and
hostile work environments can have detrimental effects on
military women in the workplace (Segal et al., 2016). In the
author's experience as a military construction worker,
benevolent sexism plays a significant role in tasks that require
heavy lifting and difficulty. Inappropriate jokes and behaviors
further fuel hostile work environments. Many times in the
workplace, the author has listened to people cite gender-specific
uniforms/standards, and physical assessments as the reason

women are a negative gain for a military unit. As military
service is historically tied to the husband/father role, this can
further hamper a women’s social identity in the military (Kelty
et al., 2010). All of the above issues can lead to reasons
military women choose to leave the service earlier than they
originally planned.
Women may use different strategies than men in their style of
leadership. In the author's experience in leadership
development, this topic was never discussed. The approach that
women use may be different based on the male-dominated
organizational structure and conservative attitudes. Women
may have to balance how assertive, feminine, or emotional
based on the context in which she is operating. Coming off too
confident may lead to people thinking of her as a "bitch" and
not conforming to gender norms. An example from the author's
life comes from watching their mother interact in a business
setting compared to home life. The author's mother would talk
very confident and straight-forward in conversation at the
workplace, but once home, she would act very feminine and
play "dumb" when talking to her husband. This personality
shift is one example of how people may change their
personalities to navigate different situations.
Women join the military as volunteers, knowing that the
military is male-dominated. Women that work in these
environments are more likely to be confident, self-motivated,
strong, and fearless (Dodds et al., 2019). The military
workforce is an up-or-out promotion system that has nearly half
of the workforce aged between 18-24 years old (Kelty et al.,
2010). Many career fields in the military still conform to
gender norms, with higher rates of females in admin and
medical career fields and males in the maintenance and
construction fields.
The Air Force and Navy tend to have service members that stay
in more prolonged and advocate for higher levels of
technological training (Clever & Segal, 2013). Towards this
point, the military continually struggles with "brain drain" in

specific career fields that promise more money in the civilian
world. In many cases, the military will offer re-enlistment
bonuses or other select pay to motivate people to stay in an all-
volunteer job. Though it should be noted that while it is
voluntary to join the military, a service commitment is signed at
the entry that must be met before the service contract can end.
Service members may terminate early due to medical, criminal,
or another service-disqualifying issue. In the Air Force,
military women have up to 12 months after pregnancy to choose
to separate from the military, if they wish to leave the service to
care for a child (Losey, 2017).
The military is well-known for extended separations and
frequent moves, the effects of which may be different for
military women than military men (Clever & Segal, 2013).
During that time away, a child of military family may have to
transition from having a two-parent household or may have to
live with a designated guardian. The family transition and
reintegration may negatively affect the child's mental well -
being (Cole, 2017). This may be especially difficult for
military women based on socially promoted gender norms of
being the primary caregiver. Understanding the unique aspects
of childrearing and care on military women can further
illuminate the challenges to reintegration after deployment and
separation (Thomas et al., 2018). If a military policy is
universal between genders concerning reintegration, but not on
primary caregiver roles, then women may be disadvantaged
when repairing family structures following deployments. These
issues may drive women to not only leave the military early but
increase the frequency of mental health conditions.
Women’s Health During and After Military Service
The ratio of women veterans is increasing, but currently, the
ages of women are significantly lower than males. The current
average age of women veterans is 48 years, compared to the
average age of male veterans of 63 (Villagran, Ledford, &
Canzona, 2015). Women veterans compared to males have
shown higher estimates for PTSD, major depression, migraine

headaches, and increased musculoskeletal disorders (Mayard,
Nelson, & Fihn, 2019). These issues are not unique to female
veterans, but the occurrence is significantly higher compared to
male veterans or civilian females.
According to a study by Sairsingh, Solomon, Helstrom, Treglia
(2018), depression is a significant health condition in female
veterans, with higher rates compared to male veterans. Due to
the cultural hindrance of acknowledging women as combatants,
health care officials may be more likely to diagnose women
with depression or anxiety instead of Post-Traumatic Stress
Syndrome (PTSD) (Heinemen, 2017). PTSD is associated with
increased risk for select autoimmune diseases, with higher rates
documented in females compared to male veterans
(Bookwalter, Roenfeldt, LeardMann, Riddle, & Rull, 2020).
PTSD for both the individual and society is costly, and due to
stigmas associated with treatment, many veterans never seek
help, drop out early, or do not benefit from treatment (Neilson,
Singh, Harper, & Teng, 2020). For female veterans,
specifically, the events that transpired to cause the mental
health conditions may be a factor in treatment.
Women's health issues differ from males, including aspects of
gynecological care, pregnancy, menopause, and a significantly
higher frequency of mental health concerns correlated to MST,
IPV (Brooks et al., 2016). A study by Dichter & True (2015)
found that sexual assault, harassment, lack of social support
were key factors to many women leaving the military early.
Women veterans are exposure to high-rates of trauma over their
lifetime to include MST and IPV, which may correlate to higher
levels of mental health needs (Evans et al., 2018). IPV rates
were shown to be 1.6 times higher for women that served in the
military (Dichter, Wagner, & True, 2015). These issues can
increase risks for eating disorders, harmful substance use, and
chronic pain (Dodds & Kiernan, 2019). Furthermore, past MST,
combined with IPV, can lead to reinforcement of beliefs about
others, oneself, and cause avoidance behavior (Mahoney,
Shayani, & Iverson, 2020). These issues may further be

associated with significantly higher suicide rates for female
veterans compared to women who had not served (Kotzias,
Engel, Ramchand, Ayer, Predmore, Ebener, Haas, Kemp, &
Karras, 2019).
According to a study by Thomas et al. (2018), an estimated 20-
40% of women that served in the military have experienced
military sexual trauma (MST). Veterans that experienced
sexual harassment or assault while in the service are twice as
likely to injure themselves or commit suicide (Kelty et al.,
2010). MST is also associated with increased rates of intimate
partner violence (IPV) towards female veterans (Evans et al.,
2018). The combination of MST and IPV in female veterans
contributes to increased risk for cognitive/mood symptoms of
PTSD (Mahoney et al., 2020). Female veterans may be
reluctant to come forward to identify these traumatic issues to
health professional or military leadership for several reasons.
Culturally, there are negative connotations towards seeking help
for mental health issues and treatment. Women in the military
may feel alienated or unwilling to report assault and rape while
in the service if they believe the military unit may turn against
them for doing so. In the military, cultural concepts of honor,
teamwork, and protecting the mission may further influence
peoples' perception of when to report crimes. These issues can
lead military women and veterans to use unhealthy or damaging
processes to combat MST and IPV, including; substance abuse,
risky behaviors, isolation, and damaging personal/family
relationships (Kelty et al., 2010). The use of "self-medication"
can further increase the chances of creating additional health
complications, rates of homelessness, and employment issues
(Berenson, 2011). The compound of effect on the lives of
women after they depart from military service may further
dissuade women from seeking help, especially at V.A. clinics.
According to Villagran et al. (2015), Women veterans report
issues of health care similar to other disenfranchised groups.
These issues include lower perceived quality of care, access to
care, provider biases, and poor health outcomes. A study by

Kehle-Forbes, Harwood, Spoont, Sayer, Gerould, & Murdoch
(2017), found 25% of women reported unwanted interactions by
male veterans at V.A. clinics while seeking care. This alone
may dissuade women veterans from seeking care at V.A. clinics,
especially those that suffered MST and IPV. Women may also
choose to hide "self-medicating" methods from V.A. staff due to
social stigma and shame (Evans et al., 2018). These issues can
lead female veterans to seek care through referrals to
community care, which can reduce their perception of care
quality (Chanfreau, Washington, Chuang, Brunner, Darling,
Canelo, & Chanfreau-Coffinier, 2019). These factors further
isolate and alienate female veterans after they leave military
service.
Future Considerations and Recommendations Section
As discussed in this paper, females make up a smaller portion
of the workforce in the United States Armed Forces compared to
men. The cultural identity of the warrior and military member
is still male-dominated and correlated with husband-provider
concepts. These concepts are reinforced outside the military in
the gender norms of U.S. society. This leads to additional
barriers for the military to promote the 'woman warrior' and
gather acceptance by both members in the military and the
greater U.S. society.
Additionally, the tendency for the military to attract and retain
military members that have a cultural identity with more
conservative-leanings may further hamper the promotion of the
'woman warrior.' A study by Neilson et al., (2020), found
“Members of the military receive implicit and explicit messages
that normalize, reinforce, and instill traditional values of
masculinity” (p.2). Based on feminist theory, these factors may
work against females both in the service and after service and
continue to promote the male-centric role of a warrior, veteran,
and provider.
The barriers women face upon entering the military, serving,
and finally earning the title of veteran, are not the same as their
male counterparts. A structural-functionalist view of the

military would see military rules and policies as a means to
organize the military into set functions and structures. On
paper, the military is a top-down hierarchal organization that
functions smoothly and promotes solidarity and stability. The
military has numerous policies and regulations to enforce these
structures that don’t discriminate against genders outright. How
non-gendered polices are accepted, implemented, and what
oversight exists, are critical to see in what manner military
functional structures may discriminate. The author found a
quote that seems to illustrate one aspect of gender issues in the
military. This issue may not specifically be in conflict with a
explicit policy, but never the less hurts female soldier’s social
capital and may restrict them from advancement. The quote is
from Segal et al., (2016):
Men’s reluctance to mentor women may be avoidance because
of stereotypes, worry about saying or doing something that will
be perceived as sexual harassment, uncomfortable or anxious
with women in general in nonsexual relationships, negative
perceptions by coworkers, or fear of spousal jealousy. (p.36)
A future recommendation is to review and analyze how policies
in the military are put into practice, and the real-world effects
on different genders. The Department of Defense can issue a
policy, but how each military branch and command implements
that policy may be different. A study of how policies may
increase or decrease gender discrimination or female retention
in the military based on practical implementation may yield
varied results across the military services. This includes a
review of policies and procedures that control and identify
issues of potential new recruits.
Each military branch has basic requirements for entrance into
the military, and unique needs for different career fiel ds. These
requirements include physical, educational, and health
standards. Understanding the unique issues women are exposed
to during and after the military should consider what mental
health issues existed before service as conditions that may
further exacerbate traumatic events during service, especially in

recruits from military families.
As discussed in previous sections, female veterans have higher
rates of depression and PTSD. Female veterans compared to
male veterans have higher rates of exposure to MST, and IPV
over their lifetime. Women that have served are more likely to
report childhood abuse and childhood adversities (Evans et al.,
2018). With higher rates of women serving, the chance of
intergenerational transmission of service should increase the
likelihood that female recruits may come from a household with
a mom that is active in or a veteran of the military (Clever &
Segal, 2013). This is especially important when considering
that roughly 35% of veterans seeking mental health care at V.A.
facilities report having children under 18 in their household
(Cole, 2017). The study by Cole (2017), added children of
veterans (with mental health issues) are more likely to display
mental health issues themselves. Finally, Evans et al. (2018)
stated that childhood adversity is a contributor to poor health,
especially in female veterans.
A recommendation based on the higher levels of depression and
mental health concerns of female veterans and exposure to MST
and IPV should seek to understand what effects there are on
female veterans' daughter’s mental health, behavioral
tendencies, and levels of intergenerational transmission of
service. Understanding the mental health needs of females
entering into military service may better help develop heal thy
mental health treatment plans and identify risk factors for
leaders.
The standards of the military preclude the acceptance of
potential recruits due to several discriminators to include
missing limbs. These policies are accepted as a necessity due to
limitations of mobility, productivity, and other performance
measures. Mental health seems to be a lagging consideration of
employment in the military, considering that it has implications
for the health of the individual, team function, and productivit y.
Once in the service, these members may find military service
non-conducive. To this point, the author found that there may

be further difficulties, limitations, and fewer veterans' services
for those that are discharged with anything less than an
Honorable Discharge.
Future consideration should be given to a study of those
discharged under lower discharge categories, the official reason,
and a qualitative review of the reasons given by witnesses and
the member. The results may provide conflicting information
when comparing the official narrative, compared to the
testimony of those members. As discussed previously, mental
health issues can lead to risky behaviors, unhealthy coping
strategies, substance abuse, and alienation. This minority
population, which may have acted out, violated regulations,
broke laws, and no longer conformed to standards due to
undetected or ignored mental health issues, may be subject to
further troubles after separation from the military. Helping to
rehabilitate these members and giving them paths for second
chances may promote a healthier veteran climate. Transitional
programs should develop techniques and tools to factor for
unique cultural, financial, and transitional needs.
The military offers a one-week Transition Assistance Program
(TAP) for separating service members (Robertson, 2013).
Within the last year, the author attended this program that
emphasized job searching and financial planning. There was a
one day workshop on utilizing V.A. services, and the overall
information of the course was surface-level of various resources
and tools. The program did little to train or assist members in
navigating the changes in identity, the changing membership of
social groups of active-duty military to a veteran, and how new
employment may not lack the same sense of purpose
(Hendricks, Haring, McDaniel, Fletcher, & Albright, 2017).
Additionally, the TAP course did little to assist members that
have cognitive injuries, which has been shown to impair
transitions to civilian work (Kelty et al., 2010). Nor did the
course take into account additional barriers female members
may have struggled with during service and how those issues
may affect their later mental health or foster obstacles to

transition (Thomas et al., 2018). These problems, if not address
during the TAP program or before service ends, may lead to
veterans feeling abandon, and unsupported by VSOs and V.A.
services (Ahern et al., 2015).
Within the last few years, the DoD has promoted a transition
program for those separating from the military called
SkillBridge. The program allows people to work for a private
company for up to 180 as an intern while still receiving full
military pay. The program seeks to help bridge the gap for
members transitioning to the civilian workforce
(DoDSkillBridge, 2019). Based on the review of the program,
the weak area seems to be that a local commander is the
approval authority for a separating or retiring member to use the
service. This allows for non-uniformity in the utilization of the
service if local commanders are unwilling to approve these
requests. The transition program is open to all transiting
members, but how applications are authorized and accepted are
subject to local leaders. If a member is not well-liked, has had
previous mental health issues, or doesn't fit accepted norms.
There is a higher probability of discrimination towards the
approval of these services. A recommendation for these
services is to promote higher-level authority for the approval
process to promote equality in access to these separating
programs. Once military service is terminated, local
commanders are no longer responsible for ensuring a
transitioning member has a social support network, and the
responsibility falls onto the member.
As discussed previously, women veterans report higher
levels of depression compared to males. A study by Sairsingh
et al., (2018), found “higher levels of social support and
financial comfort were significantly associated with lower
levels of depression” (p.136). Additionally, a lack of
understanding of women's' experiences in the military may
further dismiss traumatic events and exposures compared to
male veterans (Dodds & Kiernan, 2019). This may lead to the
public, VSOs, and the V.A. downplaying women's mental health

issues. The development of a robust social support system for
transitioning female veterans may depend on the ability of
VSOs to have practical knowledge and a specific understanding
of women veterans' experiences.
Many traditional VSOs that offer location-based services such
as the American Legion, and Veterans of Foreign Wars (VFW),
are associated with have high-levels of older male members and
unwelcoming to female veterans (Brooks, Dailey, Bair, Shore,
2016), (Thomas et al., 2018). Based on the information
reviewed by the author, legacy VSOs promote a conservative
idea of who is a military veteran, if not in policy, then by
established norms and biases of their members. Established,
large VSOs offer the ability to lobby for policies and have
longstanding social capital and prestige. Women veterans may
be disadvantaged if they are not readily active in these groups
and are regulated to new smaller VSOs or don't participate at
all. This significantly increases if women veterans suffer
mental health issues due to service-related events or negative
views of how the military systems treated them, some VSOs
may be viewed as "more of the same."
A review of VSOs may show equality as a tenant of the
organization based on policy. Still, an understanding of their
demographics and ability to conform to the changing military
demographics and military culture should be considered when
promoting VSOs for people in transition and afterward.
Working towards inclusion in VSOs, the development of social
support groups and networks for females, especially during
transition, and for those that are transitioning due to less than
ideal reasons, maybe a successful way to promote connection
and increase inclusion.
Ultimately, a change of view of transition should be a future
consideration. A military member should work on developing
civilian career field social capital like a saving plan and not a
quick rundown of how to do it, whenever military separation
arrives. While the military offers base locations for
organizations such as the USO, other VSOs could connect

military members with civilian peers to promote social capital
growth and networks.
Instilling career-long connections to the civilian sector and
collaborating with these sectors to identify trends, educational
milestones, and certification requirements may further reduce
transitional barriers for members. While not applicable in every
instance, a military culture (promoted by DoD policy) that
reinforces the need to build and maintain professional
connections in the civilian world may reduce concerns with at
least one aspect of transition for veterans.
Limitations and Biases
The goal of this research study was to identify past and current
issues surrounding the needs of women veterans. The
development of an understanding of what females in the
military endure both socially and physically is essential when
looking at issues affecting women veterans. The information
provided in the review of numerous studies gave peer-reviewed
data-points, and the author's personal anecdotes and thoughts
illuminated the subject from an individual's perspective. The
limitations and biases of this study should be noted.
The author is a white male in their late 30s from an upper-lower
class upbringing and has 20 years in the United States Air Force
in a male-dominated Civil Engineer career field. These data
points show that all perspectives of the issues come from a
third-party view concerning women's health and social issues.
The limitations of this study include the research topic being
too broad for the constraints of the assignment. While the
assignment highlighted issues both socially and health-related
for women leaving military service, it did little to dive deep
into any one specific section of the transition. Future work
should at exploring these areas of social interaction of women
in the military work-centers. How specific health issues for
women may differ across career fields and military branches.
Finally, a study to understand what safeguards and resources
exist or should be modified or improved to highlight and
assistance the largest growing segment of the veteran

population.
Conclusion
The research focus of this paper centered on issues
surrounding the need for woman's support through the transition
from the military to the civilian world. The paper sought to
highlight social and health issues women face during military
service and to acknowledge issues women veterans
disproportionally face compared to their male counterparts.
Women play a more significant and dynamic role in the Armed
Forces than ever before. Military leaders, Veterans Affairs, and
VSOs need to develop an understanding of unique health and
transition issues women face during and after military service.
References
Addario, L. (2019, October 15). On today's battlefields, more
women than ever are in the fight. Retrieved from
https://www.nationalgeographic.com/culture/2019/10/women-
are-in-the-fight-on-todays-battlefields-feature/
Ahern, J., Worthen, M., Masters, J., Lippman, S., Ozer, E., &
Moos, R. (2015). The Challenges of Afghanistan and Iraq
Veterans’ Transition from Military to Civilian Life and
Approaches to Reconnection. PLoS ONE, 10(7), 1. Retrieved
from http://search.ebscohost.com.proxy-
library.ashford.edu/login.aspx?direct=true&db=edb&AN=10862
9167&site=eds-live&scope=site.
Air Force Personnel Center. (2019, January 1). Military
Demographics. Retrieved from
https://www.afpc.af.mil/Portals/70/documents/03_ABOUT/Milit
ary%20Demographics%20Jan%202020.pdf?ver =2020-01-27-
093137-550
Assistant Secretary of the Air Force. (2000). United States Air
Force Statistical Digest F.Y. 2000. Retrieved from
https://www.afhistory.af.mil/Portals/64/Statistics/2000%20USA
F%20STATISTICAL%20DIGEST.pdf?ver=2017-04-28-100459-
630

Berenson, S. (2011). Homeless Veterans and Child Support.
Family Law Quarterly, 45(2), 173-190. Retrieved from
www.jstor.org/stable/23034388
Bialik, K. (2017, November 10). The changing face of
America’s veteran population. Retrieved from
https://www.pewresearch.org/fact-tank/2017/11/10/the-
changing-face-of-americas-veteran-population/
Bookwalter, D. B., Roenfeldt, K. A., LeardMann, C. A., Kong,
S. Y., Riddle, M. S., & Rull, R. P. (2020). Posttraumatic stress
disorder and risk of selected autoimmune diseases among U.S.
military personnel. BMC Psychiatry, 20(1), 1–8. Retrieved from
https://doi-org.proxy-library.ashford.edu/10.1186/s12888-020-
2432-9
Brooks, E., Dailey, N. K., Bair, B. D., & Shore, J. H. (2016).
Listening to the Patient: Women Veterans’ Insights About
Health Care Needs, Access, and Quality in Rural Areas.
Military Medicine, 181(9), 976–981. Retrieved from https://doi-
org.proxy-library.ashford.edu/10.7205/MILMED-D-15-00367
Burnett, S., & Segoria, J. (2009). Collaboration for Military
Transition Students from Combat to College: It Takes a
Community. Journal of Postsecondary Education and Disability,
22(1), 53–58. Retrieved from
http://search.ebscohost.com.proxy-
library.ashford.edu/login.aspx?direct=true&db=eric&AN=EJ844
Chanfreau, C. C., Washington, D. L., Chuang, E., Brunner, J.,
Darling, J. E., Canelo, I., Yano, E. M., & Chanfreau-Coffinier,
C. (2019). Exploring the association of care fragmentation and
patient ratings of care quality: A mediation analysis of women
Veterans' experience with V.A. care. Health Services Research,
54(4), 816–826. Retrieved from https://doi-org.proxy-
library.ashford.edu/10.1111/1475-6773.13153
Clever, M., & Segal, D. R. (2013). The Demographics of
Military Children and Families. Future of Children, 23(2), 13–
39. Retrieved from https://doi-org.proxy-
library.ashford.edu/10.1353/foc.2013.0018

Cole, R. (2017). Supporting Students In Military Families
During Times Of Transition: A Call For Awareness And Action.
Professional School Counseling, 20(1), 36-43. Retrieved from
http://dx.doi.org.proxy-library.ashford.edu/10.5330/1096-2409-
20.1.36
Council on Foreign Relations. (2016). Population
Representation in the Military Services: Fiscal Year 2016
Summary Report. Retrieved from https://www.cna.org/pop-
rep/2016/summary/summary.pdf
Department of Labor (2020, February). Labor Force Status of
Women & Men. Retrieved from
https://www.dol.gov/agencies/wb/data/widget#data-footnote
Dodds, C. D., and Kiernan, M. D. (2019). Hidden Veterans: A
Review of the Literature on Women Veterans in Contemporary
Society. Illness, Crisis & Loss, 27(4), 293. Retrieved from
DoDSkillBridge. (2019, June 14). What is SkillBridge?
Retrieved from https://dodskillbridge.usalearning.gov/program-
overview.htm
Dichter, M. E., Wagner, C., & True, G. (2015). Timing of
Intimate Partner Violence in Relationship to Military Service
Among Women Veterans. Military Medicine, 180(11), 1124–
1127. Retrieved from https://doi-org.proxy-
library.ashford.edu/10.7205/MILMED-D-14-00582
Dichter, M. E., & True, G. (2015). "This is the story of why my
military career ended before it should have": Premature
separation from military service among U.S. women veterans.
Affilia: Journal of Women & Social Work, 30(2), 187–199.
Retrieved form https://doi-org.proxy-
library.ashford.edu/10.1177/0886109914555219
Evans, E. A., Glover, D. L., Washington, D. L., & Hamilton, A.
B. (2018). Psychosocial Factors that Shape Substance Abuse
and Related Mental Health of Women Military Veterans who
Use Community-Based Services. Substance Use & Misuse,

library.ashford.edu/10.1080/10826084.2018.1441309
Gaither, D. (2014). Military Transition Management. Career
Planning and Adult Development Journal, 30(3), 215-239.
Retrieved from https://search-proquest-com.proxy-
library.ashford.edu/docview/1609375122?accountid=32521
Gordon, A. J., Haas, G. L., Luther, J. F., Hilton, M. T., &
Goldstein, G. (2010). Personal, medical, and healthcare
utilization among homeless veterans served by metropolitan and
nonmetropolitan veteran facilities. Psychological Services, 7(2),
65–74. Retrieved from https://doi-org.proxy-
library.ashford.edu/10.1037/a0018479
GuideStar. (n.d.). United Service Organizations, Inc. (USO
World Headquarters). Retrieved from
https://www.guidestar.org/profile/13-1610451
Harada, N. D., & Pourat, N. (2004). Does Membership in
Veterans’ Service Organizations Influence Use. Military
Medicine, 169(9), 735–740. Retrieved from https://doi-
org.proxy-library.ashford.edu/10.7205/MILMED.169.9.735
Heineman, J. A. (2017). From Boots to Suits: Women Veterans
Transitioning to Community College Students. New Directions
for Community Colleges, 2017(179), 77–88. Retrieved form
https://doi-org.proxy-library.ashford.edu/10.1002/cc.20264
Hendricks, K., Haring, E., McDaniel, J., Fletcher, K., &
Albright, D. (2017). Belonging and Support: Women Veterans’
Perceptions of Veteran Service Organizations. Journal of
Veterans Studies, 2, 2. Retrieved from https://doi-org.proxy-
library.ashford.edu/10.21061/jvs.12
Houseworth, C. A., & Grayson, K. (2019). Intermarriage and the
U.S. Military. Armed Forces & Society. 45(4), 659. Retrieved
Hrcv.uso.org. (n.d.). USO Pathfinder Program. Retrieved from
https://hrcv.uso.org/programs/uso-pathfinder-program
Jahnke, S. A., Haddock, C. K., Carlos Poston, W. S., & Jitnarin,

N. (2014). Priorities of legislatively active veteran services
organizations: a content analysis and review for health
promotion initiatives. Military Medicine, 179(11), 1331–1338.
Retrieved from https://doi-org.proxy-
Kehle-Forbes, S. M., Harwood, E. M., Spoont, M. R., Sayer, N.
A., Gerould, H., & Murdoch, M. (2017). Experiences with VHA
care: a qualitative study of U.S. women veterans with self-
reported trauma histories. BMC Women’s Health, 17, 1–8.
library.ashford.edu/10.1186/s12905-017-0395-x
Kelty, R., Kleykamp, M., & Segal, D. R. (2010). The Military
and the Transition to Adulthood. Future of Children, 20(1),
181–207. Retrieved from https://doi-org.proxy-
library.ashford.edu/10.1353/foc.0.0045
Kotzias, V., Engel, C. C., Ramchand, R., Ayer, L., Predmore,
Z., Ebener, P., Haas, G. L., Kemp, J. E., & Karras, E. (2019).
Mental Health Service Preferences and Utilization Among
Women Veterans in Crisis: Perspectives of Veterans Crisis Line
Responders. Journal of Behavioral Health Services & Research,
library.ashford.edu/10.1007/s11414-018-9635-6
Lemmon, M., Whyman, M., & Teachman, J. (2009). Active-duty
military service in the United States: Cohabiting unions and the
transition to marriage. Demographic Research, 10. Retrieved
library.ashford.edu/login.aspx?direct=true&db=edsdoj&AN=eds
doj.96980fbaae5429e86836afee44b964a&site=eds-
live&scope=site.
Losey, S. (2017, April 29). New Air Force policy gives new
mothers 12 months to decide if they want to stay in uniform. Air
Force Times. Retrieved from
https://www.airforcetimes.com/news/your-air-
force/2017/04/29/new-air-force-policy-gives-new-mothers-12-
months-to-decide-if-they-want-to-stay-in-uniform/
Mahoney, C. T., Shayani, D. R., & Iverson, K. M. (2020).

Differential indirect effects of military sexual trauma on
posttraumatic stress disorder symptom clusters via past-year
intimate partner violence experiences. Traumatology. Retrieved
from https://doi-org.proxy-
library.ashford.edu/10.1037/trm0000242
Neilson, E. C., Singh, R. S., Harper, K. L., & Teng, E. J.
(2020). Traditional masculinity ideology, posttraumatic stress
disorder (PTSD) symptom severity, and treatment in service
members and veterans: A systematic review. Psychology of Men
& Masculinities. Retrieved from https://doi-org.proxy-
library.ashford.edu/10.1037/men0000257
Robertson, H. (2013). Income and Support during Transition
from a Military to Civilian Career. Journal of Employment
Counseling, 50(1), 26. Retrieved from
Robertson, H., & Brott, P. (2013). Male Veterans’ Perceptions
of Midlife Career Transition and Life Satisfaction: A Study of
Military Men Transitioning to the Teaching Profession.
Adultspan Journal, 12(2), 66. Retrieved from
Russell, C. A., & Russell, D. W. (2018). It’s not just showing
up: How social identification with a veterans service
organization relates to benefit-finding and social isolation
among veterans. Psychological Services, 15(2), 154–162.
library.ashford.edu/10.1037/ser0000176
Sairsingh, H., Solomon, P., Helstrom, A., & Treglia, D. (2018).
Depression in Female Veterans Returning from Deployment:
The Role of Social Factors. Military Medicine, 183(3/4), e133–
e139. Retrieved from https://doi-org.proxy-
library.ashford.edu/10.1093/milmed/usx065
Scharf, M., Mayseless, O., & Kivenson-Baron, I. (2011).

Leaving the parental nest: Adjustment problems, attachment
representations, and social support during the transition from
high school to military service. Journal of Clinical Child and
Adolescent Psychology, 40(3), 411–423. Retrieved from
https://doi-org.proxy-
library.ashford.edu/10.1080/15374416.2011.563464
Segal, M. W., Smith, D. G., Segal, D. R., & Canuso, A. A.
(2016). The Role of Leadership and Peer Behaviors in the
Performance and Well-Being of Women in Combat: Historical
Perspectives, Unit Integration, and Family Issues. Military
Medicine, 181, 28–39. Retrieved from https://doi-org.proxy-
Thomas, K. H., McDaniel, J. T., Haring, E. L., Albright, D. L.,
& Fletcher, K. L. (2018). Mental health needs of military and
veteran women: An assessment conducted by the Service
Women’s Action Network. Traumatology, 24(2), 104–112.
library.ashford.edu/10.1037/trm0000132
Thornton, G. (2016, December 31). Consolidated Financial
Statements and Report of Independent Certified Public
Accountants United Service Organizations, Inc. Retrieved from
https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=w
eb&cd=43&cad=rja&uact=8&ved=2ahUKEwjLpsi-5u7nAhVB-
qQKHXovB5U4KBAWMAJ6BAgDEAg&url=https%3A%2F%2F
uso-dot-
org.s3.amazonaws.com%2Fdocument%2F72%2F258904f8-7e14-
43db-9673-accb64f56315.pdf&usg=AOvVaw0ln-
xBHtJCpZKKpZUrbuoa
United States Census Bureau. (2018). Veterans, 2014-2018.
Retrieved from
https://www.census.gov/quickfacts/geo/chart/US/VET605218
United States Census Bureau. (2017). History and Evolution of
Veteran Status Questions. Retrieved from
https://www.census.gov/topics/population/veterans/about.html
United Service Organizations. (n.d.). Retrieved from
https://www.uso.org/

Chapter 9
Nutrition in Childhood and Adolescence
Nutrition in Childhood and Adolescence
A small number of U.S. children eat the recommended amount
from Food Guide Pyramid for grains, fruits, vegetables, dairy
products, and meat or meat alternatives.
Majority consume high calorie-dense snacks and meals, added
sugars, and larger portion sizes.
Total fat, saturated fat, and sodium intake are above
recommended levels.
They consume large amounts of beverages high in added sugars
(soft drinks and fruit drinks).
Nutrition Status of Children and Adolescents in the United
States Continued
Healthy People 2010’s (HP) goal is to increase the proportion of
adolescents who participate in daily school physical education
to 50 percent.
To increase the proportion of adolescents who engage in
moderate physical activity (> 30 minutes on > 5 days of the
previous 7) and activity that promotes cardiorespiratory fitness
three days per week.
Growth and Physical Development and Assessment: Physical
growth slows down during the preschool and school years until
the pubertal growth spurt of adolescence.
States Continued
Growth and Physical Development Continued

By age 2, children quadruple their birth weight.
They gain an average of four and a half to six and a half pounds
(2 to 3 kg) per year between the ages of 2 and 5.
Between these ages, children grow 2 1/2 to 3 1/2 inches (6 to 8
cm) in height per year.
A 1-year-old child has several teeth and digestive and metabolic
systems are functioning at or near adult capability.
States Continued
Eating behaviors of toddlers include:
Feeding themselves independently during the second year of
life.
Using a cup, with some spilling, at 15 months.
Two-year-olds prefer fingers foods.
Playing with food and refusing any help.
Toddlers tend to be apprehensive of new foods offers about 15
times.
They are curious about new foods, but may be reluctant to try
them.
See Table 9-1 for Food Guide for Toddlers and Preschoolers.
States Continued
Using Surveys to Monitor Nutrient Intake: Healthy Eating Index
(HEI) represents different aspects of a healthful diet.
It provides an overall picture of the type and quality of foods
people eat.
Their compliance with specific dietary recommendations, and
the variety in their diets.
Children ages 2 to 3 mean score for fruits and vegetables was

significantly higher compared with older children's scores.
Nutrition-Related Concerns During Childhood and Adolescence
Iron Deficiency Anemia: Many iron-deficient children come
from low-income families with poor diets.
Cultural traditions and lack of nutrition knowledge for iron
requirements are factors that contribute to iron deficiencies.
Iron deficiency is defined as:
Absent bone marrow iron stores
An increase in hemoglobin concentration
< 1.0g/dl after treatment with iron
Continued
Iron Deficiency Anemia Continued
Other abnormal laboratory values, such as serum ferritin
concentration
Children 1 to 2 years of age are diagnosed with anemia if:
Hemoglobin concentrations were < 11.0 g/dl and hematocrit <
32.9 percent.
Children ages 2 to 5 years, a hemoglobin value of 11.1 g/dl or
hematocrit of 33.0 percent.
Low blood iron levels affect the child’s resistance to disease,
attention span, behavior, and intellectual performance.
Continued
Lead Poisoning can cause iron deficiency, and an iron
deficiency can impair the body’s ability to prevent lead
absorption.
Satisfactory calcium intake may slow lead’s absorption or
interfere with its toxicity.
Lead poisoning is common among children under age six and

can cause:
learning disabilities and behavior problems
slow growth
brain damage and central nervous system damage
Continued
Strategies for preventing lead poisoning include providing:
nutritious foods
screening children for lead poisoning
preventing children from eating non-food items
avoiding water-containing lead and preventing children from
putting dirty or old painted objects in their mouths
Continued
Dental Caries: About 1 in 5 children ages 2 to 4 years has decay
in the primary or permanent teeth.
Suggestions for reducing dental caries:
Brush teeth to remove carbohydrates from the teeth.
Rinse the child’s mouth with water.
Use fluoridated water.
Give crunchy foods such as carrot sticks and apple slices for a
snack (less likely to promote tooth decay than sticky candies or
raisins).
Continued
Overweight and Obesity: Overweight and obesity is the
accumulation of excess body fat.
Body Mass Index (BMI) between 85th and 95th percentile for
age and sex is considered at risk for overweight.
BMI at or above the 95th percentile is considered overweight or

obese.
Continued
Factors that contribute to obesity in children and adolescents
include:
the amount of television viewing
inactivity and sedentary lifestyle
genetic factors
environmental factors
cultural environment seem to play major roles in the prevalence
of obesity worldwide
medical causes such as hypothyroidism and growth hormone
deficiency
Continued
Medical Problems Related to Childhood Obesity: Common
medical problems in obese children and adolescents are
hypercholesterolemia, dyslipidemia, and hypertension and can
affect cardiovascular health.
The endocrine system (hyperinsulinism, insulin resistance,
impaired glucose tolerance, type 2 diabetes mellitus, and
menstrual irregularity)
Mental health (depression, and low self-esteem)
Some children may develop sleep apnea, liver and gall bladder
diseases, osteoporosis, and some cancers
Continued
Dealing with Overweight and Obesity: Childhood eating and
exercise habits can be modified more easily than adult habits.
Focus on parents’ knowledge of nutrition.

Parental education should include information about low -fat
foods, good physical activities, and monitoring of television
viewing.
Continued
High Blood Cholesterol: Atherosclerosis is a progressive,
complex disease that often begins in childhood and adolescence.
Atherosclerosis is related to high serum total cholesterol levels,
low-density lipoprotein, very low-density lipoprotein, and high-
density lipoprotein levels.
Children and adolescents with elevated LDL-cholesterol levels,
often have family members with high incidence of coronary
heart disease.
Dieting Behavior and Abnormal Eating: 95 percent of
individuals diagnosed with clinical eating disorders are female.
Continued
Dieting Behavior and Abnormal Eating Continued
It is estimated that 0.5-1 percent of the general population
suffers from anorexia, 2 percent from bulimia nervosa, and 2
percent from binge eating disorders.
Factors contributing to eating disorders:
Sociocultural pressures
Onset of bulimia nervosa usually follows a period of dieting to
lose weight
Dietary restraint may contribute to bulimia
Continued
Criteria for Eating Disorders
Anorexia nervosa

BMI of less than 17.5 kg/m2 in adults
Intense fear of gaining weight, and absence of anorexi a nervosa
Amenorrhea for postmenarchal female
Disturbance in the way in which body size or weight is
perceived
Bulimia nervosa
Recurrent episodes of binge eating
Recurrent purging behavior
Too much exercise or fasting
Self-evaluation overly influenced by body shape and weight
Continued
Provisional criteria for binge eating:
Recurrent episodes of at least three behavioral and attitudinal
characteristics, such as:
Eating large amounts when not physically hungry
Feeling disgusted or guilty after overeating
Eating much more rapidly than normal
Occurs on average at least 2 days a week for 6 months
Regular use of purging, fasting, and too much exercise
Malnutrition in Children
Malnutrition and hunger are responsible for nearly half of the
deaths of preschool children throughout the world.
Deficiencies in vitamin A, zinc, iron, and protein results in
illness, stunted growth, and limited development, and in the
case of vitamin A, possibly permanent blindness.
Malnutrition in Children Continued
Malnutrition includes undernutrition, which means not
consuming enough nutrients, and overnutrition, which includes
excessive consumption of any particular nutrient.

Children, mainly infants and those under 5 years of age are at
an increased risk for undernutrition due to increased need of
energy and nutrients.
Protein-Energy Malnutrition (PEM) occurs throughout the life
cycle, but it is more common during infancy/childhood.
PEM is classified into two parts:
Primary
Secondary
In most cases, PEM is caused by a combination of both.
Primary
Biological
Maternal malnutrition prior to or during pregnancy and lactation
Genetic factors
Sociological
Poverty
Unavailability of food
Ecological
Disasters leading to famine
Profound social inequalities either at the individual level
(discrimination, refugees, prisoners) or at the community or
country level
Secondary
Biological conditions that interfere with food intake
Congenital anomalies (e.g., cleft lip)
Gastrointestinal problems that may cause malabsorption of

nutrients (e.g., tropical sprue)
Genetic factors (e.g., phenylketonuria)
Biological conditions that increase energy and nutrients needs
AIDS
All infectious diseases accompanied with fever
Secondary Continued
Other diseases that increase catabolism (e.g., tuberculosis)
Social causes
Lack of education
Inadequate weaning practices
Child abuse
Alcoholism and other drug addictions
The Prevalence and Effect of Malnutrition in Children in the
United States: About 13 million children live in families with
incomes below the federal poverty level.
About 20 percent of children under 6 years old live in poor
families.
Approximately 17.8 percent of the children 6 years or older live
in poor families.
About 15.6 percent of households with children under 6 years
old were food-insecure.
Children and Adolescents with Special Healthcare
Needs/Childhood Disability
The prevalence of childhood disability is increasing: about 7–18
percent of children and adolescents ages birth to 18 years in the
United States have a chronic physical, behavioral,
developmental, or emotional condition.
There are various causes of developmental disabilities and

special healthcare needs are comprehensive.
Needs/Childhood Disability Continued
They may have physical impairments, developmental delays, or
chronic medical conditions that are caused by or related with
these factors:
Genetic conditions (diabetes, sickle cell anemia, etc.)
Congenital infections
Inborn errors of metabolism (phenylketouria, lactose
intolerance, galactosemia, etc.)
Prematurity
Neural tube defects
Maternal substance abuse
Environmental toxins (lead mercury, etc.)
Nutrition risk factors may be physical, biochemical,
psychological, or environmental in nature.
Physical conditions such as a cleft lip or palate.
Biochemical conditions such as:
A disease process such as galactosemia may limit an
individual’s ability to feed, digest, or absorb food.
Drug nutrient interactions may alter digestion, absorption or the
bioavailability of nutrients from the diet.
Psychological conditions such as depression or stress that may
alter an individual’s appetite and motivation to follow a
specified diet plan.
Environmental factors such as:

Family and social support
Finances
To receive the nutrition benefits, the child must have a diet
prescription from a physician.The prescription must include:
A statement identifying the disability and how the disability
affects the adolescent’s diet.
The prescription must include (continued):
A statement identifying the major life activity affected by the
disability.
A specific list of dietary changes, modifications, or
substitutions required for the diet.
The Effect of Television on Children’s Eating Habits
Children watch an average of 3 hours of advertisements per
week and 19,000 to 22,000 commercials over a 1-year period.
Children from families with high-television use consume an
average:
6 percent more of their total daily energy intake from meats
5 percent more from pizza, salty snacks, and soda
About 5 percent less of their energy intake from fruits,
vegetables, and juices than children from families with low -
television use
Nutrition During Childhood and Adolescence
Nutrients most likely to be low or deficient are calcium, iron,
zinc, vitamin B6, and vitamin A.
Children living in poor families are more likely to consume
diets that are low in calories; vitamins A, C, E, and B6, folate,
iron, zinc, thiamin, and magnesium.
Growth and Development during puberty:

Height and weight increase.
Many organ systems enlarge.
Increase in lean body mass and changes in the distribution of
fat.
Nutrition During Childhood and Adolescence Continued
Growth and Development Continued
Normally, growth spurts begin between ages 10.5 and 11 for
girls, and peak at about 12 years of age.
Boys’ growth spurts start between 12.5 and 13 and peak at about
age 14. This spurt lasts about two years.
The most rapid linear growth spurt for an average boy occurs
between 12 and 15 years of age.
During adolescence:
Boys gain more weight than girls.
Boys experience greater increases in lean body mass.
Girls accumulate more body fat.
Specifically around the hips and buttocks, upper arms, breasts,
and upper back.
Adolescent Eating Behaviors are not static; they fluctuate
throughout adolescence.
They may use foods to establish individuality and to express
their identity.
Experimentation may lead to certain eating behaviors such as
skipping meals.
Breakfast is the most-skipped meal.
Reasons for their change in eating habits.
Spending less time with family and more time with their peer
group.

They eat more meals and snacks away from home, including
many fast foods high in fat and calories.
The average teenager eats at fast food restaurants twice a week.
Fast-food visits account for 31 percent of all food eaten away
from home and make up 83 percent of their visits to restaurants.
Food and Nutrition Programs for Children and Adolescents
National School Lunch Program was established in 1946 and is
under the direction of the USDA.
Children at or below 130 percent poverty level are eligible for a
free lunch.
School Breakfast Program began as a pilot project in 1966 and
was made permanent in 1975.
Special Milk Program was established in 1955 by USDA.
Summer Food Service was established in 1975 after a pilot
program in 1968.
Food and Nutrition Programs for Children and Adolescents
Team Nutrition Program started in 1995 by USDA.
To “improve the health and education of children through better
nutrition.”
Head Start was established in 1965 program for children
between the ages of 3 and 5 for low-income families.
Provides education, health services (medical, nutritional, dental,
and mental health), and social services.
National Youth Sports Program (NYSP) is a federal program
designed to assist low-income children ages 10 to 16 in a
summer program.
Challenges to Implementing Quality School Nutrition Programs

School meals face a variety of challenges:
Students’ preferences for fast foods, soft drinks, and salty
snacks
Mixed messages sent by school personnel
School food preparation and serving space limitations
Inadequate meal periods
Lack of education standards for school food service directors
Challenges to Implementing Quality School Nutrition Programs
Continued
Promoting Successful Programs in Schools: Encouraging
healthful behaviors may be achieved through implementation of
a Coordinated School Health Program (CSHP).
A CSHP would combine health education, disease prevention,
health promotion, and access to health and social services in an
integrated comprehensive manner.
As a pilot project for the San Francisco Unified School District
(SFUSD), Aptos Middle School made changes in its vending
and à la carte food service programs.
The purpose of the project was to establish nutrition standards
for competitive foods.
The principal, a physical education program, and a group of
parents, teachers, and volunteers initiated the change in the food
service program.
This group met electronically (via e-mail) to share concerns and
data and to attain a consensus.
Successful Community Strategies Continued
Changes instituted included:
Removed soft drinks from the vending machines located in the
physical education department and replaced with bottled water.

Fruit options for students were expanded beyond apples,
oranges, and bananas to include kiwifruit, grapes, strawberries,
and melons.
Jicama, raw broccoli, spinach, and romaine lettuce were
available for salads.
Soft drinks were removed from the à la carte line in the
cafeteria and replaced with water, milk, and 100-percent juice
(no more than 12 ounces per serving)..
High-fat foods, such as French fries and nachos, were removed
from cafeteria meals.
High-fat/high-sugar foods were removed from the à la carte line
and replaced with fresh, healthier options and more appropriate
portion sizes.
The new food options included turkey sandwiches, sushi,
homemade soup, salads, and baked chicken with rice.
Vending machines, and any other food sold outside cafeterias
adhered to these standards.
Topics for Discussion
What are the nutrients most likely to be deficient in school-age
children and adolescence?
What are the causes of PEM?
What are the nutrition-related risk factors for children and
adolescents with special healthcare needs?
What are some of the challenges facing school meal programs?
What are the eating behaviors of adolescents and toddlers?
What are the contributing factors to eating disorders and the
difference between bulimia and anorexia nervosa?
Chapter 11

Promoting Health and Preventing Disease in Older Persons
Nutrition, Longevity, and Demographics of Older Persons
Aging is a biological, psychological, and social process that
most individuals will experience.
The average life expectancy at birth increased from 47 years in
1900 to 77.8 years in 2004.
Most deaths occurred after age 65.
The goal to increase life expectancy and the number of years of
healthy life is known as compression of morbidity.
Continued
Compression of morbidity can be achieved by slowing the
biological changes that accrue over time and delaying the
diseases of aging.
Research suggests that a diet based on rice, fish, vegetable
protein sources, fruits, vegetables, and some meat contributes to
longevity.
Successful aging is trying to discover the rewards of a life fully

lived to the end.
Continued
The four features of successful aging identified by Fisher are:
Interactions with others
Autonomy and sense of purpose
Personal growth
Self-acceptance
Continued
Kerschner viewed older adults as representing:
An opportunity rather than a crisis
A solution rather than a problem
An asset rather than a burden
A resource rather than a drain on resources
A group that can make social, economic, and cultural
contributions

Leading Causes of Death and Disability in Older Persons
Heart disease and cancer are the leading causes of death for all
persons age 65 or older and in all ethnic groups.
Other chronic health conditions are:
Cerebrovascular diseases (stroke)
Chronic lower respiratory diseases
National Goals—Healthy People 2010: The goal of the DHHS
Healthy People 2010 initiative is to help individuals of all age s
increase life expectancy and improve their quality of life.
Theories of Aging
The theories proposed to explain the aging process are:
Genetic
Environment
Lifestyle factors
Genetic, Environment, and Lifestyle Theory—genes determine
the competence with which cells are maintained and repaired.

Theories of Aging Continued
Genetic, Environment, and Lifestyle Continued
Environmental factors include pollution, poor living conditions,
lifestyle habits related to diet, smoking, alcohol abuse, and
level of physical activity. These all influence the expression of
the genetic code.
Free Radicals Theory—free radicals are unstable oxygen
compounds formed normally during metabolism and can damage
cells.
Exposure to oxidizing agents such as environmental pollutants,
ozone, smoking, and solar radiation can also damage the cells.
Free radicals cause oxidative damage to proteins, lipids,
carbohydrates, and DNA and may indirectly destroy cells by
producing toxic products.
Cell damage due to free radicals has been implicated in
diseases, such as cardiovascular disease and cancer.

Unstable oxygen compounds can be neutralized when they
combine with an antioxidant.
Antioxidants enzymes produced by the body are catalase,
glutathione, peroxidase, reductase, and superoxide dismutase.
Dietary antioxidants include selenium, vitamins E and C, and
other phytochemicals.
Phytochemicals are plant substances such as beta-carotene,
lycopene, and flavonoids, that contribute to normal metabolism.
Caloric Restriction Theory is the nutritional model that has been
successful in prolonging life in mice, rats, and other rodents.
Studies show that dietary restriction in rats increased longevity,
but led to diminished sexual maturation and fertility, lower
bone strength, and lower bone calcium and phosphorus contents.
The best caloric restriction approach is to add more fruits and
vegetables to a diet.
Eating nutrient-dense foods and avoiding obesity enhances
prospects for longevity.

Lifestyle and Socioeconomic Factors That May Influence the
Aging Process
Social and economic factors affects aging and can affect the
nutritional status such as:
Alcohol Use
Increased Use of Medications and Aging
Dependent Living
Income Level
Aging Process Continued
Alcohol Use: Consumption increases the risk of malnutrition in
older persons.
Limit alcohol intake to no more than one drink: 4 to 5 ounces of
wine or 12 ounces of beer.
Symptoms of alcoholism in older persons include trembling
hands, sleep problems, memory loss, and unsteady gaity.
Thirteen percent of elderly men and 2 percent of elderly women
suffer from alcoholism.

Increased Use of Medications and Aging: Persons at highest risk
for Drug Nutrient Interactions (DNI) are those that:
Take many drugs, including alcohol
Require long-term drug therapy
Have poor or marginal nutrition status
Almost half of older Americans take multiple medications daily
(polypharmacy).
Situations contributing to increased risk of DNI are:
taking more drugs for longer periods
drugs may be more toxic
variability in responding to drugs
bodies have less capability to handle drugs efficiently
poor nutritional status
making mistakes in self-care because of illness, mental
confusion, or lack of drug information

Increased Use of Medications and Aging Continued
Drugs can affect nutritional status by changing food intake
patterns.
Medications may interfere with an individual’s ability to
prepare meals.
Dependent Living: The number of older U.S. adults living alone
increased in the past three decades.
Dependent Living Continued
Older adults that live alone are vulnerable to poverty and social
isolation, which affects the quality of food intake and could
lead to malnutrition.
Income Level: About 3.6 million elderly persons live bel ow the
poverty level.
The highest rates of poverty occur among the oldest of the old,
minorities, women, older foreign born, persons living alone, and
those with disabilities.

Food is the most flexible expense in the budget, limiting the
types and amounts consumed.
Physiologic Changes That Can Affect Nutritional Status
Aging causes multiple physiologic changes that affect nutrient
needs and nutritional status.
Changes in lean body mass
Aging bone
Changes in taste, smell, appetite, and digestive juices
Continued
Changes in Lean Body Mass: Body weight decreases after age
60 in men and age 65 in women by an average of 0.5 percent
yearly.
Older adults gain body fat and lose about 53 to 60 percent of
total body water.
Aging Bone: a decrease in bone density. After age 40, adults
lose stature with a mean height loss of 4.9 cm (1.9 inches) in
women and 2.9 cm (1.1 inches) in men.

Risking osteoporosis, which is a major cause of morbidity in
developed countries.
Nutrients that contribute to bone density are protein, vitamins
C, D and K, phosphorous, and calcium.
Continued
Changes in Taste, Smell, Appetite, and Digestive Juices: The
secretion of digestive juices is diminished.
Gastric acid is reduced that leads to bacterial growth, causing
formation of gas.
A reduction in the absorption of pH-dependent nutrients such as
vitamins C, B12, B6 and folic acid.
Continued
Changes in Taste, Smell, Appetite, and Digestive Juices
Continued
A decrease in parietal cell secretion of an intrinsic factor, which
binds vitamin B12 hence, impairing its bioavailability.

Sensory perceptions of taste, smell, hearing, and vision may
change.
Hunger and satiety cues are fewer than in younger adults.
This type of satiety is associated with a decreased intake of one
food and a switch to another food during that ingestion period.
The sensory-specific satiety mechanism promotes more variety
and a more well-balanced eating, which is diminished in older
persons.
Continued
Chemosensory losses that occur with age include the following:
Ageusia: Absence of taste
Hypogeusia: Diminished sensitivity of taste
Dysgeusia: Distortion of normal taste
Anosmia: Absence of smell
Hyposmia: Diminished sensitivity of smell
Dysosmia: Distortion of normal smell
Anorexia in the Elderly

Anorexia and weight loss are common in the elderly, especially
in individuals suffering from medical or mental illnesses.
The standard for monitoring body weight is the loss of 10
pounds or more over a period of 6 months or the loss of 5
percent or more of total body weight over a period of 1 year.
Anorexia in the Elderly
Failure to thrive is a syndrome in infants and children who are
neglected; characterized by a failure to grow both physical and
socially.
In older persons, this condition is characterized as a failure to
maintain as the individual regresses in physical well-being and
mental function.
Weight loss is the first major symptom of failure to thrive in
older adults, plus physical disability, loss of skills for self-care,
social withdrawal, diminished mental function, and death.
Water Requirements
Phillips et al. defined dehydration as losing nearly two percent
of initial body weight.

This can occur after not drinking any fluid and consuming only
dry foods for 24 hours.
The regulation of body water relies on thirst and an individual’s
response to that thirst.
Dehydration can be diagnosed in those with high serum sodium
levels (> 150 milliequivalents per liter) or a high ratio of blood
urea nitrogen to creatinine (> 25).
Water Requirements Continued
The symptoms of dehydration include:
A swollen tongue
Constipation
Electrolyte imbalance
Nausea and vomiting
Hypotension
Mental confusion, sunken eyeballs
Increased body temperature and decreased urine output,
pressure ulcers, and urinary tract infections
Water Requirements Continued

A general guideline of total fluid intake for older adults is 3.7
liters per day for men and 2.7 liters per day for women
Alzheimer’s Disease
The prevalence of Alzheimer’s disease varies from about 3
percent in persons age 65 years to almost 50 percent in those
over 85 years.
Alzheimer’s disease begins with cognitive loss that gradually
becomes worse with the extension of cerebral lesions.
Alzheimer’s disease affects many different cells involving the
neurotransmitters with symptoms of memory loss, behavior and
personality changes, reduced ability to think, and weight loss.
Multivitamin/Mineral Supplement
Many older persons use supplements. Supplements containing
megadoses or non-nutrient substances may be toxic.
For example: Superoxide dismutase (SOD) is an enzyme that
protects against oxidative damage and supposedly slows down
aging can be used to treat Alzheimer’s.

Multivitamin/Mineral Supplement Continued
SOD is a protein that is broken down to amino acids in the GI
tract, so oral supplements will not increase blood or tissue
levels of this enzyme.
Coenzyme Q is marketed to older persons as improving the
immune system; it does not boost immune function and may be
dangerous for people with poor circulation.
Nutrition Screening for Older Persons
Nutrition Screening Initiative (NSI) checklist was developed to
identify the risk of malnutrition among older persons.
The checklist uses the mnemonic “Determine” to help users
determine poor nutritional status.
A score of 0 to 2 is considered good nutritional status, and a
recheck in 6 months.
A score of 3 to 5 is moderate risk and a recheck in 3 months.

Nutrition Screening for Older Persons Continued
A score of 6 or more indicates high nutritional risk and those
with that score are encouraged to see a physician, dietitian, or
other health or social service.
Major indicators of poor nutritional status are shown in Table
11-5 in the text.
These can be identified through interview, observation, physical
examination, anthropometric measurements, and laboratory
tests.
Nutrition Screening for Older Persons Continued
Risk factors include:
Inappropriate food and nutrient intake
Poverty, social isolation
Dependency and disability
Acute or chronic diseases or conditions
Chronic medication use
Functional disability
Hunger
Living alone
Depression
Dementia

Nutrition Assessment
Older populations can be assessed using any of these forms:
surveys, surveillance, screening, or interventions.
Research results show that older persons with poor dental health
had lower dietary intake levels of vitamin A, carotene, folic
acid, and vitamin C, and scored low on variety of diet.
A comprehensive nutrition assessment should include the
ABCDs discussed in Table 11-6.
Nutrition Services That Promote Independent Living

Government programs to address nutritional needs of older
adults include:
The USDA’s Food Stamp and Extension programs
Adult Day Services, Nutrition Assistance Program for Seniors
(NAPS)
The Elderly Nutrition Program (ENP)
The Elderly Nutrition Program (ENP) created in 1972
Nutrition Services That Promote Independent Living Continued
The Elderly Nutrition Program provides congregate and home-
delivered meals.
Meals served under the program must provide at least one-third
of the Recommended Dietary Allowances.
Box 11-6 in the text presents nutrition programs for promoting
health and preventing diseases in older persons.
Home Healthcare Services
Home health services can help older individuals avoid
institutionalization due to illness.
About 28 percent of older persons over 65 years are unable to

perform one or more Activities of Daily Living (ADLs).
12.9 percent reported difficulties with Instrumental Activities of
Daily Living (IASLs) without the assistance.
Home Healthcare Services Continued
Activities for Daily Living: Older person’s ability to care
for him- or herself is evaluated using ADLs and IADLs.
ADLs evaluates ability to:
Bathing oneself
Dressing oneself
Feeding oneself
Using the toilet
Home Healthcare Services Continued
IADLs evaluates ability to:
Prepare meals
Perform house-cleaning
Handle money and balance a checkbook
Shop without help
Use the telephone

Leave the house without help
The Seattle Senior Farmers’ Market Nutrition Program
collaborated with five organizations including the University of
Washington.
They supplied a market basket that contained a variety of
seasonal local fresh fruits and vegetables to 480 homebound
low-income seniors.
The goal was to increase the fresh fruit and vegetable intake of
homebound Meals on Wheels participants.
Subjects for both the intervention and control groups were
recruited via flyers that were delivered by Meals on Wheels
drivers.
The Meals on Wheels drivers volunteered to deliver the market
baskets to the participants’ homes every 2 weeks.
Participants were recruited using newsletter that provided
recipes for less common seasonal foods and via telephone

interviews before basket deliveries.
Mailed a serving-size guide with pictures of representative
foods. Participants were required to have the guide with them at
the time of the telephone survey.
Discussion Topics
What are the lifestyle and socioeconomic factors that may
influence the aging process?
What are the symptoms of dehydration among older adults?
What are the leading causes of death and disability in older
persons?
What are the theories of aging?
What are the physiologic changes that can affect nutritional
status of older persons?
Chapter 10
Adulthood: Special Health Issues

Chapter 18 Private and Government Healthcare Systems Pri

Chapter 18 Private and Government Healthcare Systems Pri

Recommended

Recommended

More Related Content

Similar to Chapter 18 Private and Government Healthcare Systems Pri

Similar to Chapter 18 Private and Government Healthcare Systems Pri (20)

More from MorganLudwig40

More from MorganLudwig40 (20)

Recently uploaded

Recently uploaded (20)

Chapter 18 Private and Government Healthcare Systems Pri