Old soldiers never die,
Never die, never die,
Old soldiers never die
They just fade away.

From an old Army ballad made famous in a speech by Gen. Douglas MacArthur

That song was sung proudly by troops at the turn of the last century; it was believed to have originated in Britain around 1900 and adapted into an American version during World War I.

Despite the lyrics, the reality was that young soldiers born around the turn of that century and fighting in Europe from 1914-1918 not only died, but died very young by current standards. A male born in 1900 had a life expectancy of 47 years old, assuming he even survived the Battle of the Somme or Verdun.

Brenda L. Mooney Editorial Director

The realities are very different nearly 100 years later. Life expectancy jumped to 62 by 1940, around when today’s 70-somethings were born. Many have exceeded those expectations. In 2010, nine million veterans were 65 and older.

The U.S. Census Bureau says the oldest old, those 85 years old and over, will be the fastest-growing segment of the elderly in the next century.

This presents some new dilemmas for the VHA. Who is too old to benefit from lung or colon cancer surgery? At what age should PSA screening end for prostate cancer? Both of those issues are addressed in this year’s 2012 Compendium of Federal Medicine.

VA medical providers deal every day with an older patient population suffering from  chronic diseases that have constantly changing treatment paradigms. To help you keep up, we offer articles on strategies to initiate earlier insulin therapy in patients with diabetes, to manage the complicated combination of multiple sclerosis and chronic conditions, and to incorporate new research into rosacea care.

We also offer an article on the controversial efforts at VA to explore HIV prevention with prophylaxis to augment its efforts to improve treatment by universal diagnosis. Veterans with HIV tend to be older than in the general population, with two-thirds over the age of 50. VA reports that 80 of its patients were older than 80 in 2010, with that number jumping to 180 by 2011.

Many of VA’s efforts to improve the quality and delivery of care are focused on conditions that disproportionately strike the older population, including stroke and HCV – both covered in this edition.

One of the greatest challenges for federal healthcare, however, is that, at the same time the needs of older veterans are being met, a new generation of patients is pouring into the system.

Over the past decade, more than 2.1 million Americans have served more than 3 million tours of duty. More than 1.25 million veterans from these conflicts have returned home; 90,000 were wounded in action or injured seriously enough to require medical evacuation. So far, 600,000 have been treated in VA facilities, with more than 500,000 applying for disability claims related to service.