Late-life exacerbation of PTSD symptoms in US veterans: results from the National Health and Resilience in Veterans Study.

Abstract

More than 60% of US military veterans are 55 years or older. Although several case studies have suggested that older age is associated with a higher likelihood of reactivated or delayed-onset posttraumatic stress disorder (PTSD) symptoms in veterans, population-based data on the prevalence and determinants of this phenomenon are lacking. Using data from the National Health and Resilience in Veterans Study (NHRVS: Wave 1 = October 2011-December 2011; Wave 2 = September 2013), a nationally representative, cohort study of US veterans, we evaluated the prevalence and determinants of exacerbated PTSD symptoms in 1,441 veterans 55 years or older using a DSM-IV-based measure in 2011 and a DSM-5-based measure in 2013. Veterans whose worst trauma occurred at least 5 years prior to Wave 2 of the NHRVS (mean = 28.6 years) and who reported a clinically significant increase (ie, ≥ 0.5 standard deviation [SD]; mean = 1.27, SD = 0.78) in PTSD symptoms from Wave 1 (lifetime) to Wave 2 (past-month) were identified as having exacerbated PTSD symptoms. Results revealed that 9.9% of older US veterans experienced exacerbated PTSD symptoms an average of nearly 3 decades after their worst trauma. A multivariable logistic regression model indicated that greater self-reported cognitive difficulties at Wave 1 independently predicted exacerbated PTSD symptoms at Wave 2. Post hoc analysis revealed that this association was driven by greater severity of executive dysfunction (adjusted odds ratio range, 1.27-3.22). Approximately 1 in 10 older US veterans experiences a clinically significant exacerbation of PTSD symptoms in late life. Executive dysfunction may contribute to risk for exacerbated PTSD symptoms. These results suggest that exacerbated PTSD symptoms are prevalent in US veterans and highlight potential targets for identifying veterans at risk for this phenomenon.