Posttraumatic Stress Disorder In Older Adults Research Articles

Posttraumatic stress disorder among older adults: A differential item functioning analysis of PTSD in ICD-11 and DSM-5.

Distinct models of posttraumatic stress disorder (PTSD) are outlined in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the 11th version of the International Classification of Diseases (ICD-11). Limited data exists about the validity of these models among older adults. This study examines the probable prevalence rates of PTSD in older adults; the factorial validity of both models; and symptom-endorsement bias across sex. Using a nationally representative (United States) sample (n = 5,366) of older adults aged 60 years and older, alternative PTSD factor models were tested using confirmatory factor analysis (CFA), and item bias was assessed using differential item functioning (DIF) analysis. PTSD was measured without the functional impairment criterion, likely resulting in inflated prevalence rates. DSM-5 (9.5%) PTSD prevalence was significantly higher than ICD-11 (8.7%). Women were more likely to meet criteria for DSM-5 (OR = 1.79) and ICD-11 (OR = 1.38) PTSD. CFA results showed that both models of PTSD had excellent fit. Four DSM-5 symptoms demonstrated DIF, with females more likely to endorse three symptoms (B1: "unwanted memories"; B4: "feeling upset"; and E6: "sleep problems") and males more likely to endorse one symptom (E2: "reckless or self-destructive behavior"). No DIF was present for the 6 ICD-11 symptoms. Both PTSD models perform well among older adults, although there is evidence of DIF in the DSM-5 model. A considerable proportion of older adults met diagnostic requirements for PTSD, thus highlighting the importance of trauma-related research among older adult populations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Prolonged Exposure Therapy With an Older Adult: An Extended Case Example

Prolonged exposure therapy (PE) has gained strong empirical support for posttraumatic stress disorder (PTSD) in the general population. However, some authors have suggested that exposure therapies may be less effective for the treatment of PTSD in older adults. There is a paucity of empirical treatment studies for older adults with PTSD. The extant studies are briefly reviewed. There are indications that exposure therapies can be feasible, safe, and efficacious for older adults. However, the degree and maintenance of gains may be reduced in older adults relative to younger adults. A case example is presented to provide a detailed illustration of PE conducted with an older adult. The treatment is presented in five phases, including standard treatment components and suggested modifications for older adults. The modifications include careful use of terminology, slowing down the presentation of some information, involvement of family members, and utilizing technology to minimize the negative effects of physical impairments and stigma.

COGNITIVE AND NEURAL MECHANISMS OF THE ACCELERATED AGING PHENOTYPE IN PTSD

Introduction Posttraumatic Stress Disorder (PTSD) affects 6.8% of adults in the United States and is associated with high rates of disability, comorbid medical and psychiatric disorders, and suicide. Older adults make up an increasingly large proportion of PTSD patients as the population skews older and Veterans from recent conflicts age. PTSD in older adults is often chronic, leads to increased mortality from cardiovascular disease and other medical conditions, and promotes adverse aging associated syndromes such as frailty. Moreover, older PTSD patients exhibit faster cognitive decline and have twice the risk of dementia compared to individuals without PTSD. Accelerated biological aging may explain these findings, as PTSD is associated with similar brain changes to those occurring with cognitive aging, including bilateral hippocampal volume reductions specifically in the cornu ammonis 3 (CA3) and dentate gyrus (DG) sub-regions and increased microvascular lesions (white matter hyperintensities). The goal of this presentation is to describe ongoing work from our laboratories characterizing the mechanisms by which PTSD accelerates aging cognitively and physically. We will present data linking cognitive dysfunction in PTSD with indicators of brain health such as DG CBV and increased white matter hyperintensities and physical decline with increased levels of inflammation and oxidative stress. Methods To date. N=17 adults 50 years and older with PTSD and N=9 trauma exposed healthy controls (TEHCs) have undergone testing to assess cognitive function and physical performance. Neuropsychological testing and magnetic resonance imaging (MRI) including cerebral blood volume (CBV)-fMRI were used to assess cognitive function and brain health. Neuropsychology testing included a modified form of the Benton Visual Retention Task (ModBent), a task that has been validated as a measure of DG function relative to age. Tasks such as gait speed and tests of strength, including grip strength and the short physical performance battery, were used to assess physical decline. Inflammatory markers IL-6, CRP, and telomere length, and urinary isoprostanes, a measure of oxidative stress, were also used to examine physical decline. Measures were compared between the PTSD patients and trauma exposed healthy controls. We expect to substantially increase the sample size available for presentation by the time of the Annual Meeting. Results Enrolled PTSD subjects to date show deficits in every cognitive domain when compared to the TEHC, particularly on measures of processing speed and executive function, where their performance is > 1 SD below that of age-matched TEHCs. CBV fMRI (N=15) analyzed to date shows PTSD patients to have diminished DG CBV compared to TEHC, and lower DG CBV is associated with increasing symptom severity as measured by the Clinician Administered PTSD Scale (r=-0.49). Reaction time on ModBent increased (worsened) with increasing symptom severity (r=0.50). Overall hippocampus volume is smaller in PTSD patients than TEHC (d=-.23), although PTSD patients have on average greater ICV (d=0.30). PTSD patients also display deficits in every physical performance task compared to the TEHC patients and report reduced physical activity and worse physical conditions. PTSD patients have higher levels of inflammatory markers IL-6 (d=0.18) and CRP (d=0.25) as well as urinary isoprostanes (d=0.05), a marker of oxidative stress. Conclusions These data indicate that PTSD, particularly chronic PTSD, is associated with unhealthy aging trajectories. These findings are consistent with the hypothesis that older adults with PTSD have marked neurocognitive and physiologic performance decrements compared to age-matched TEHC. This research was funded by NIMH. PDF: http://submissions.mirasmart.com/Verify/AAGP2019/Original/AAGP2019-000325/AAGP2019-000325_Fig1.pdf

EMDR in Older Adults With Posttraumatic Stress Disorder

Recognition of posttraumatic stress disorder (PTSD) in older adults is often difficult due to its complicated presentation. Once recognized, trauma symptoms can, in accordance with (inter)national guidelines, be successfully treated with eye movement desensitization and reprocessing (EMDR) therapy. However, limited empirical research has been done on the expression and treatment of PTSD in older adults. This article explains trauma and age in the context of psychotherapy. It discusses the interaction between age and pathology and summarizes the cognitive issues related to age, PTSD, and anxiety. It provides practical suggestions for how these can be addressed in treatment. Age-related challenges related to motivation are identified with practical suggestions for addressing them. The case illustrates the necessary additions and subtractions for older adults, with clear explanations and instructions. This article points the way for future research.

Predictors of the new criteria for probable PTSD among older adults

The definition of post-traumatic stress disorder (PTSD) changed in the fifth edition of the Diagnostic and Statistical Manual (DSM-5) and it is yet unclear how these changes affect the diagnosis of PTSD among older adults. The present study examined the contribution of demographic characteristics, functioning status, health related factors, as well as exposure to rocket attacks to prediction of probable PTSD in older adults. Three-hundred and thirty-nine community-dwelling adults (age range 50-90; M=65.44, SD=9.77) were sampled through random dialing to Jewish residents in the south of Israel. Participants completed a phone-questionnaire that collected background information and reports of relevant symptoms. Analyses showed that self-rated health, incidence of depression episodes, and exposure to rocket attacks predicted the DSM-5 definition of PTSD as well as the subscale of negative alternations in cognition and mood. The current study delineates the unique set of predictors of probable PTSD in older adults, with an emphasis on negative alternations in cognition and mood. Greater attention to unique predictors of PTSD in the second half of life is called for.

Brief Eclectic Psychotherapy for an Older Dutch Woman With Late-Onset Posttraumatic Stress Disorder Complicated by a Cerebral Vascular Accident

Posttraumatic stress disorder (PTSD) is a mental disorder that is known to have deleterious psychological, physical, and social impacts on individuals. Recognition of PTSD in older adults is difficult due to the complicated presentation taking into account that PTSD symptoms may be masked by other psychiatric and/or somatic diagnoses that are more common in older adults. Furthermore, some older adults may underreport their PTSD symptoms, and the relationship between current symptoms and distant traumas may be difficult to detect. Limited empirical research has been done on the manifestation, course, and treatment of PTSD in older adults. In this article, the literature on PTSD in older adults is reviewed, including discussion of common diagnostic problems, illustrated by a case report of an older woman with late-onset PTSD after a cerebral vascular accident (CVA). In conclusion, identifying PTSD in older adults can be difficult. However, detecting PTSD in older adults is critically important so that possibly hidden or masked trauma symptoms can be addressed in treatment, even if there are complicating factors such as a CVA.

Posttraumatic stress disorder in older adults: an overview of characteristics and treatment approaches

Posttraumatic stress disorder (PTSD) is a common and disabling condition following a traumatic event. Despite its high prevalence rates, relatively little is known about the manifestation and course of the disorder in older adults. Moreover, there has been little evaluation of the efficacy of psychotherapeutic treatment approaches for older patients. This overview aims to summarize available data on the prevalence and symptoms of late-life PTSD and to review the current treatment approaches for older adults. The course and severity of PTSD symptoms in older adults depend on the time the trauma occurred (early versus late life). In the case of acute traumatization, lower prevalence rates and symptom severities are generally observed in older than in younger populations. In the case of early-life traumatization, a decline in PTSD symptom severity can be observed over the life course. Research on treatment approaches has produced promising results, indicating that disorder-specific interventions (i.e., trauma confrontation and cognitive restructuring) can be effectively combined with an age-specific narrative life-review approach. Given the limited empirical evidence, caution is warranted in generalizing the reported findings. Nevertheless, it is possible to draw a number of conclusions concerning the characteristics and treatment of PTSD in older adults. Further research is needed to better understand the various presentations of PTSD in late life and to validate and improve the effectiveness of available treatment approaches.

Late-Onset Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is a complex psychological response to a perceived life-threatening trauma that includes re-experiencing the trauma, avoidance, intrusive thoughts, hyperarousal, and dissociation. Exposure to trauma in early adulthood increases the potential for further psychological threats throughout life. In older adult populations, PTSD is an underrecognized and undertreated disorder that can result in psychosocial disability, substance use, and other negative health outcomes. This article examines the range of symptoms related to PTSD in older adults and expands on health care provider sensitivity to the interrelationship of mental and physical health when addressing the needs of older adults with this disorder.

Posttraumatic Stress Disorder and Aging

The evidence base on effective treatments for posttraumatic stress disorder (PTSD) in the elderly population is scarce. The assessment and treatment of PTSD could pose a challenge for primary care providers and residents in training involved in treating PTSD in older adults. This article will review the epidemiology, the morbidity, the mortality, the biological perspective, the prognosis, and the psychosocial and pharmacological treatment options, in addition to the spiritual dimensions of PTSD and aging.

Traumatic Exposure and PTSD in Older Adults: Introduction to the Special Issue

All too often traumatic exposure and its effects receive little or no consideration in studies of adult development and aging. This is perplexing, as evidence has shown that for a large number of individuals in the general population, trauma has harmful physical, social, and psychological effects. This conundrum has led some researchers to call traumatic exposure and its effects “hidden variables” in the lives of older adults (Nichols and Czirr, 1986; Spiro et al., 1994). When many professionals and the general public do give consideration to the consequences of traumatic exposure, they almost always equate them with posttraumatic stress disorder (PTSD). This assumption is only partially correct. Trauma can evoke heterogeneity of psychological symptoms. In fact, Herman (1992) suggests that responses to trauma are best understood as a spectrum of conditions rather than as a single disorder. Those in the field of geropsychology must be made aware that although the prevalence of full diagnostic criteria for PTSD is relatively low in older adults, there are other long-term psychological effects of traumatic exposure that require assessment and treatment. In fact many health practitioners could benefit from increased understanding of trauma in older adults. Misattribution of older adults’ trauma-related symptoms can have serious implications for treatment and recovery, such as the design of inappropriate or inadequate treatment plans, administration of ineffective psychotherapy treatments, dispensing of unnecessary medications, or costly, inefficient medical intervention (Allers et al., 1992). Although there are several excellent special issues of journals devoted to the topic of trauma among older adults in the past two decades (Blau, 1997; Elder and Clipp, 1994; The aging survivors of the Holocaust, 1981; Wigder, 1997), there is a need for an update. The recent terrorist attacks in this country and abroad will no doubt lead to further research on and clinical practice of retraumatization and its effects. The goal of this special issue is to highlight some of the most innovative research and clinical endeavors occurring in the field of geriatric trauma in the hopes of stimulating greater interest in and exploration of this topic. One of the strengths of these papers lies in their diversity. The papers address a broad range of topics from prevalence and phenomenology to treatment in older adult survivors of traumas with various types and durations of exposure (e.g., Holocaust, natural disaster, combat, prisoner of war, rape and childhood abuse).