Most older adults have been exposed to trauma in their lifetime
Up to 90% of older adults have experienced at least one traumatic event in their lifetime, such as military combat, the unexpected death of someone close, serious illness or injury to self or someone close.1,2
Exposure to trauma is associated with posttraumatic stress disorder and several other psychological disorders in older adults
Population-based studies involving older adults in the United States have found that the lifetime prevalence of full posttraumatic stress disorder (PTSD) ranges from 2.8% to 4.5% and that an additional 5.5% have partial or subsyndromal PTSD.1 These conditions, which may persist for more than a decade, often co-occur with mood and anxiety disorders, such as major depression and generalized anxiety disorder.1,2 In some countries, traumatic experiences related to war in early life are common and may be associated with elevated PTSD symptoms, even decades later.2
Traumatic experiences and PTSD are associated with several physical health conditions in older adults
People who have experienced trauma or have PTSD have higher rates of cardiovascular diseases and related risk factors (e.g., hypertension, coronary artery disease, hyperlipidemia), as well as other common medical conditions (e.g., osteoarthritis, diabetes)3,4 (Appendix 1, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.120866/-/DC1).
Screening instruments are effective in identifying people with symptoms of PTSD
Available evidence suggests that instruments such as the PTSD Checklist and the Primary Care PTSD Screen are useful in screening for probable PTSD.5 The cut-off point that provides optimal sensitivity and specificity on instruments such as the PTSD Checklist may be lower for older adults than for younger people.5
Data regarding PTSD treatments for older adults are lacking
Preliminary empirical data and case studies indicate positive treatment outcomes of psychotherapies, such as cognitive-behavioural therapy and life-review therapy for elderly individuals with PTSD.6 Patients with comorbid depression may benefit from a collaborative approach including antidepressant medication.7
Resources
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PTSD Checklist: www.ptsd.va.gov/professional/pages/assessments/ptsd-checklist.asp
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Primary Care PTSD Screen: www.ptsd.va.gov/professional/pages/assessments/pc-ptsd.asp
Footnotes
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Competing interests: Robert Pietrzak has served as a consultant for CogState. None declared for Philipp Kuwert and Heide Glaesmer.
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This article has been peer reviewed.
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- Most older adults have been exposed to trauma in their lifetime
- Exposure to trauma is associated with posttraumatic stress disorder and several other psychological disorders in older adults
- Traumatic experiences and PTSD are associated with several physical health conditions in older adults
- Screening instruments are effective in identifying people with symptoms of PTSD
- Data regarding PTSD treatments for older adults are lacking
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