This chapter examines the very long-term effects of war. Central to this is a study I carried out a few years ago with WWII veterans (Hunt, 1997; Hunt and Robbins, 2001a, b). It addresses the extent and nature of war-related distress experienced by the veteran population, and the factors that predict such distress. The effects of traumatic stress on the older population are exacerbated by developmental changes, which in themselves are stressors. These include diminished sensory capacity, reduced mobility, frailty, reduced income and social status due to retirement, loss of friends and subsequent isolation, ill health and reduced self-care (Cook, 2001), though many people do not experience significant decline in their cognitive abilities, and many develop special expertises. Major physical and mental decline often does not occur until very advanced age (Coleman, 1999).

War has very long-term or permanent effects (Hunt, 1997; Spiro et al., 1994; Bramsen and van der Ploeg, 1999), though some of the symptoms may be less marked than in younger people (Fontana and Rosenheck, 1998). For instance, dissociation may be less persistent over time (Yehuda et al., 1995). There may also be complications involving coexistent syndromes, or different patterns of symptoms; for instance, Goenjian et al.