Posttraumatic Stress Disorder in Older Adults: A Conceptual Review

ABSTRACT

Objectives: We provide a review of the literature on posttraumatic stress disorder (PTSD) in older adults, focusing largely on older U.S. military veterans in two primary areas: 1) assessment and diagnosis and 2) non-pharmacological treatment of PTSD in late life.

Methods: We performed a search using PubMed and Academic Search Premier (EBSCO) databases and reviewed reference sections of selected papers. We also drew on our own clinical perspectives and reflections of seven expert mental health practitioners.

Results: Rates of PTSD are lower in older compared with younger adults. The presence of sub-syndromal/partial PTSD is important and may impact patient functioning. Assessment requires awareness and adaptation for potential differences in PTSD experience and expression in older adults. Psychotherapies for late-life PTSD appear safe, acceptable and efficacious with cognitively intact older adults, although there are relatively few controlled studies. Treatment adaptations are likely warranted for older adults with PTSD and co-morbidities (e.g., chronic illness, pain, sensory, or cognitive changes).

Conclusions: PTSD is an important clinical consideration in older adults, although the empirical database, particularly regarding psychotherapy, is limited.

Clinical Implications: Assessment for trauma history and PTSD symptoms in older adults is essential, and may lead to increased recognition and treatment.

KEYWORDS:

• Older adults
• posttraumatic stress disorder
• psychotherapy
• trauma

Disclosure Statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was partially supported by a VA Rehabilitation Research and Development (VA RR&D) Service award IK2 RX001832-01A2 of the US Department of Veterans Affairs (Pless Kaiser, PI). This material is the result of work supported with resources and the use of facilities at VA Boston Healthcare System. We thank the clinicians who provided insights into their clinical work with older adults with PTSD and the veterans who have allowed us to contribute to their healthcare. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.