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Press Release
VA Studying Treatments for Gulf War Illnesses
More than 30 VA medical centers across the country are participating in the first large-scale clinical trials for treatments of the unexplained illnesses of Gulf War veterans. The Department of Veterans Affairs is leading a $20 million effort with the Department of Defense to learn more about ways to improve the health of veterans suffering from symptoms such as fatigue, muscle and joint pain, and problems with memory and thinking.
"Despite the lack of a comprehensive clinical case definition of the symptom complex often called Gulf War veterans’ illnesses, VA has identified subgroups of patients for whom certain therapies may be appropriate," said John R. Feussner, M.D., VA’s Chief Research and Development Officer and chairperson of the Research Working Group of the Persian Gulf Veterans Coordinating Board.
One study will focus on exercise and cognitive behavioral therapy (CBT). CBT is a highly structured treatment strategy that teaches techniques for diminishing the severity of symptoms. CBT and exercise training have been shown to be effective in treating many chronic ailments, including cancer, coronary artery disease, asthma and various conditions characterized by pain and/or fatigue. A second project will test whether a hypothetical infectious cause for the symptoms can be effectively treated with an antibiotic.
The exercise/behavioral therapy trial will involve 20 sites across the country and 1,300 veterans. Participants will receive their care exclusively from specially designated clinics and will work with a health care provider specifically assigned to the study. The trial will test whether the two forms of therapy—separately or in combination—improve physical function in veterans with at least two of the otherwise unexplained symptoms of fatigue, muscle and joint pain, and memory and thinking problems. Volunteers will receive aerobic exercise training, cognitive behavioral therapy, both, or usual and customary medical care in the trial clinic.
By studying a large number of veterans at multiple sites, this trial is designed to demonstrate definitively whether exercise alone or in combination with behavioral therapy improves health. The trial is not aimed at curing Gulf War veteran’s illnesses but will evaluate non-drug therapies for reducing the severity of symptoms and thus allowing veterans to function at a higher level.
The other treatment trial will test whether the antibiotic doxycycline (a tetracycline) improves the health of veterans who test positive for infection with the common microorganism Mycoplasma and have at least two of the three symptoms of fatigue, muscle and joint pain, and memory and other neurologic problems. One current hypothesis for the unexplained ailments of Gulf War veterans is infection by a Mycoplasma species known as Mycoplasma fermentans.
Some veterans have reported that doxycycline helps to treat their ailments, but a large-scale, scientific study is needed to systematically test this therapy. The new trial will involve more than 400 veterans at 30 medical centers. To be eligible, volunteers must test positive for infection with Mycoplasma and must have at least two of the three symptoms of fatigue, muscle and joint pain, and memory and other neurologic problems. Participants will be randomly assigned to receive a 12-month course of doxycycline or an inactive placebo. Because of the importance of this health problem and the need for a scientifically valid study, veterans who receive the placebo will make a critical contribution that potentially could benefit many veterans suffering from GWI.
Gulf War veterans interested in volunteering for either of the clinical trials may contact the study coordinator at the nearest participating site. Sites and telephone numbers for the studies are listed below.
Participating Sites
Exercise/Behavioral Therapy Trial
VA Medical Centers
Albuquerque, NM (505) 265-1711, ext. 2587
Birmingham, AL (888) 820-1102
Boston, MA (617) 232-9500, ext. 5968
Brooklyn, NY (718) 630-2819
Burlington, VT (802) 864-4492
Dayton, OH (937) 268-6511, ext. 1212
East Orange, NJ (800) 248-8005
Fargo, ND (701) 239-3700, ext. 3502
Houston, TX (713) 794-7668
Philadelphia, PA (215) 823-5952
Portland, OR (503) 494-1104
Richmond, VA (888) 289-1632
St. Louis, MO (314) 289-6554
San Antonio, TX (210) 617-5300, ext. 4061
San Francisco, CA (415) 221-4810, ext. 2287
San Juan, PR (787) 758-7575, ext. 5656
Seattle, WA (206) 764-2795
West Haven, CT (203) 932-5711, ext. 3990
White River Junction, VT (802) 295-9363, ext. 6052
DoD Medical Centers
Naval Health Research Center
San Diego, CA (619) 524-0069
Walter Reed Army Medical Center
Washington, DC (202) 782-6563
Participating Sites
Antibiotic Treatment Trial
Albany, NY (518) 462-3311, ext. 3080
Albuquerque, NM (505) 265-1711, ext. 2396
Augusta, GA (706) 733-0188, ext. 2305
Birmingham (888) 820-1102
Boston, MA (617) 278-4416
Bronx, NY (800) 877-6976
Brooklyn, NY (718) 630-2819
Charleston, SC (843) 577-5011, ext. 7376
Dayton, OH (937) 268-6511, ext. 1212
Durham, NC (919) 286-6950
East Orange, NJ (800) 248-8005
Fargo, ND (701) 239-3700, ext. 3502
Houston, TX (713) 794-7543
Manchester, NH (603) 624-4366, ext. 6898
Milwaukee, WI (414) 384-2000, ext. 2760
Montgomery, AL (334) 272-4670, ext. 4466
Nashville, TN (615) 327-4751, ext. 7852
New Orleans, LA (504) 568-0811, ext. 5491
Oklahoma City, OK (405) 270-0501, ext. 3106
Omaha, NE (402) 977-5632
Philadelphia, PA (215)823-5952
Providence, RI (401) 457-3045
Richmond, VA (888) 289-1632
Salt Lake City (801) 582-1565, ext. 1466
San Francisco, CA (415) 221-4810, ext. 2287
San Juan, PR (787) 758-7575, ext. 3311
Tampa, FL (813) 974-0798
White River Junction, VT (802) 295-9363, ext. 6054
DoD Medical Centers
Naval Health Research Center
San Diego, CA (619) 524-0069
Walter Reed Army Medical Center
Washington, DC (202) 782-6563
February 1999
VA Programs for Older Veterans
The number of Americans age 65 and older is expected to increase from 31 million in 1990 to nearly 59 million in 2025 as the baby boom generation of the 1940s and 1950s ages. VA, however, has been faced with the graying of the veteran population for some time. Currently, the median age of World War II veterans is estimated at 73.8 years. Today, nearly 9 million veterans are age 65 and older -- 34.8 percent of the overall veteran population. By 2000, the number of veterans age 65 and older will peak at 9.3 million and represent 38.2 percent of the total veteran population. On an average, the elderly have more chronic medical problems than younger persons. Their need for health-care services, especially long-term care, is much greater, creating a challenge to VA's healthcare system. That challenge is being met through a variety of programs directed toward the special, complex needs of the aging veteran population.
Nursing Home Care
VA's 132 nursing home care units, based at VA medical centers, provide skilled nursing care and related medical or psychosocial services. A comprehensive care management system is coordinated by an interdisciplinary team. In FY 1998, more than 47,000 veterans were treated in these facilities. Veterans who have been hospitalized in a VA facility for treatment, primarily for a service-connected condition, may be placed, at VA expense, in community facilities. In FY 1998, VA contracted with 3,500 community nursing homes to provide care to more than 28,900 veterans. Through the State Nursing Home Program, VA contributes to the construction costs of the nursing home and provides partial per diem grant payments to the state for veterans placed in a state home. There are 90 state nursing homes in 43 states, with an average daily cencus of 12,600 patients.
Domiciliary Care
VA facilities and VA-supported state homes provide domiciliary care, or residential rehabilitation and health maintenance centers, for veterans who do not require hospital or nursing care but are unable to live independently because of medical or psychiatric disabilities. They receive necessary medical and psychiatric care, rehabilitative assistance, and other therapeutic interventions on an outpatient basis from the host hospital, while residing in the structured, therapeutic, homelike environment of the domiciliary. VA operates 40 domiciliaries with nearly 5,878 beds. An additional 5,841 beds for domiciliary care are available at 46 state homes.
Hospice and Respite Care
VA's hospice care program provides pain management, symptom control, and other medical services to terminally ill veterans, as well as bereavement counseling and respite care for their families. Each facility has a hospice consultation team consisting of a physician, nurse, social worker, and chaplain to plan, develop and implement a program of hospice services.
Respite care is a program designed to relieve the spouse or other caregiver from the burden of caring for a chronically ill veteran at home. This is done by admitting the veteran to a VA hospital or nursing home for planned, brief periods of care, generally lasting 2-4 weeks. The long-range benefit of this program is that it enables the veteran to live at home with a higher quality of life than would be possible in an institution. It may also provide the veteran with needed treatments during the inpatient stay, maintaining or improving functional status and prolonging the veteran's capacity to remain in the home. There are respite care programs at 136 VA medical centers. While they vary in size, each typically provides care to approximately five veterans on any given day.
Geriatric Evaluation Management Programs
Geriatric Evaluation Management (GEM) programs provide comprehensive health-care assessments, therapeutic interventions, rehabilitative care and long-range term care plans for primarily older veterans with multiple medical, functional and/or psychosocial problems and those with particular geriatric problems, such as early-stage dementia, urinary incontinence or falls. GEMs are aimed at keeping frail elderly out of nursing homes. Programs are staffed by an interdisciplinary team composed of a physician, nurse, social worker, and other health professionals skilled in assessing and treating geriatric patients. The first GEM was opened in June 1976 by the Geriatric Research, Education and Clinical Center at the VA Medical Center in Little Rock, Ark. Today, there are 110 GEMs systemwide.
Noninstitutional Long-Term Care
While VA provides care to veterans in nursing homes and domiciliaries, and pays for care for certain veterans in private community nursing homes and state veterans homes, VA also developed a number of long-term care programs in noninstitutional settings. These programs have grown out of the philosophy that a home or community setting is the desired location to deliver long-term care, and that nursing home placement is a last resort. Within VA, this type of care includes hospital-based primary care, adult day health care, homemaker/home health aide services and community residential care programs.
* Hospital-Based Primary Care -- provides primary medical care to chronically ill veterans in their own homes under the coordinated care of interdisciplinary treatment teams. In FY 1998, VA operated programs at 71 sites and served an average of 6,360 patients a day, for a yearly total 13,224 patients.
* Adult Day Health Care -- provides health maintenance and rehabilitative services to frail individuals in a group setting during daytime hours. Introduced in the late 1970s at five VA facilities, by 1998 VA operated 14 programs directly and provided contract services at 83 VA medical centers, providing care to approximately 1000 veterans daily.
* Homemaker/Home Health Aide Services -- In April 1993, VA initiated a pilot program of health-related services for service-connected veterans who would otherwise be in a nursing home. These services, provided in the community by public and private agencies, include such things as light housekeeping, meal preparation, bathing, dressing, feeding, medication management, and assistance with medical equipment. VA staff directly provides case management of these services. Homemaker/home health aide services were purchased for 118 VA medical centers, serving more than 2,300 veterans during 1998.
* Community Residential Care -- provides room, board, limited personal care and supervision to veterans who do not require hospital or nursing care but are not able to live independently because of medical or psychiatric infirmities, and have no family to provide needed care. In 1998, approximately 9,300 veterans were provided care in 2,100 homes.
Alzheimer's Disease and Other Dementias
Dementia is characterized by intellectual deterioration, including disturbances in memory as well as impulse control, language, spatial abilities, and judgment severe enough to interfere with social or occupational functions. Alzheimer's disease, the most common form of dementia, is characterized by a gradual onset of symptoms with progressive intellectual deterioration. The number of veterans with severe dementia is expected to rise from 200,000 in 1983 to 600,000 in the year 2000 and then remain relatively stable through 2030. An equal or higher number of veterans is estimated to have mild to moderate dementia. As the number of veterans with dementia rises, the number of veterans seeking VA care is also expected to rise.
VA's program for veterans with Alzheimer's disease and other dementias is decentralized throughout the medical-care system. Many medical centers have established specialized programs for the treatment of veterans with dementing illnesses. Veterans with dementia participate in all aspects of the health-care system, including outpatient, acute and extended-care programs. A number of educational resources have been developed by VA for training staff to provide care to dementia patients and to work with family caregivers. Many of these resources have been disseminated to the general public as well. In addition, VA investigators are actively involved in research on the causes and treatment of Alzheimer's disease and other dementias. During FY 1997, 217 primary investigators at 66 VA medical centers received $3.4 million in VA and $19.7 million in non-VA funding for such research. Five of VA's 16 Geriatric Research, Education and Clinical Centers have a primary or secondary research focus on Alzheimer's disease and other dementias.
Ensuring Quality Geriatric Staff
The impact of VA's geriatric programs is not limited to its own health-care system, but extends to broader levels. VA's Geriatric Research, Education and Clinical Centers (GRECCs) and Geriatric Fellowship Program began in the late 1970's and have played a critical role in the development and recognition of geriatric medicine as a new specialty in the United States. As geriatrics became a recognized specialty, the fellowship positions in geriatric medicine converted to residency positions. Since that time, any VA medical center may conduct training in geriatrics, provided a properly accredited program is in place.
To further develop a cadre of professionals committed to clinical excellence and to becoming leaders of local and national geriatric programs, VA also developed other specialized fellowship programs. Those include the following: Dentist Geriatric Fellowship Program, Fellowship Program in Geriatric Psychiatry, Gerontological Nursing Fellowship Program, Geriatric Neurology Fellowship Program and the Geropsychology Fellowship Program. Lastly, VA has been a leader in interdisciplinary team training (ITT), having developed 12 ITT programs in geriatrics in the late 1970's, which in recent years have expanded their focus to primary care and other clinical areas where a team approach is most effective for patient care.
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