Relatively little is known about trauma and PTSD in older adults in comparison to young and middle-aged adults. In fact, up until the past decade, large-scale epidemiological studies examining the prevalence and impact of trauma did not include sufficient numbers of older adults to adequately examine the effects of age. More recent investigations of community-dwelling adults in the US generally indicate that older adults report fewer traumatic events and related psychiatric symptoms than younger individuals. For example, the prevalence of past-year PTSD was significantly higher for younger (4.3%) and middle-aged (5.2%) adults compared with older adults (2.6%) and so were the odds of comorbid psychiatric disorders.1
However, some have surmised that trauma is a hidden variable in the lives of older adults, impacting them in ways they may not recognize or be willing to admit.2 For instance, older adults may have experienced trauma but do not recognize the potential deleterious health effects or do not disclose these experiences to health care providers. Moreover, health care providers may not recognize trauma and related distress in older adults. This lack of recognition or misattribution of trauma-related symptoms can have negative implications for treatment and recovery, including the design of ineffective treatment plans and administration of incongruous psychotherapy, medication, or other medical intervention.
Prevalence of PTSD in older adults
Although the majority of older adult trauma survivors are not affected with PTSD, those that are or show other related distress are of note. For example, in a large nationally representative prospective cohort study with over 2000 US veterans aged 60 and older, a total of 3.5% met screening criteria for current PTSD—many had significantly increased odds of mood, anxiety, and substance use disorders, suicidal ideation, and suicide attempts.3 Most of the veterans in this cohort were resilient, having few to no psychiatric symptoms. They exhibited higher emotional stability, social connectedness, protective psychosocial characteristics, and positive perceptions of the military’s effect on one’s life.
Trauma and PTSD in the older adult population has also been linked to physical health problems, disabilities, and poorer cognitive functioning. In a large, longitudinal study of older community-residing male veterans, combat exposure and PTSD were both negatively related to self-reported physical health and to physician-diagnosed medical conditions that included arterial, gastrointestinal, and musculoskeletal disorders.4 Data from three aggregated nationally representative samples show that older adults with chronic PTSD were three times more likely to have any disability than were those with no PTSD.5 And, in a sample of over 10,000 veterans aged 65 and older, those with PTSD had almost twice the odds of having a diagnosis of dementia.6
There are few longitudinal studies of PTSD across the lifespan but in general it appears that if symptoms occur early in life and are untreated, they often wax and wane across the lifespan. As one ages and transitions into older adulthood, there is typically an increased likelihood for loss and the impact of such events can exacerbate symptoms. Furthermore, as one transitions into older adulthood, there is an increased risk for medical illness, decrements in functional status, bereavement, retirement, changes in social and familial roles, diminishing of control, and more time for reflection—all of which can deepen the impact of PTSD.
Dr McCarthy is a Consultant, Executive Division, VA Department of Veterans Affairs’ National Center for PTSD, White River Junction, VT; Dr Cook is a Researcher, Evaluation Division, VA Department of Veterans Affairs’ National Center for PTSD, West Haven, CT, and an Associate Professor of Psychiatry, Yale School of Medicine, New Haven, CT.
The authors report no conflicts of interest concerning the subject matter of this article.
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