Post-Traumatic Stress Disorder in Seniors

Definition

Post-traumatic stress disorder (PTSD) is a severe psychological condition that causes feelings of helplessness or overwhelming fear as a result to of viewing or being a part of a traumatic event that causes death , serious bodily harm, or severe emotional injury. These events may include loss of a loved one, natural disasters, acts of war, physical or emotional abuse, grave illness, or sexual or physical assault. PTSD can be psychologically disabling and lead to a host of other psychological problems if left untreated.

Description

PTSD was originally coined to describe the shock or fatigue many Vietnam War veterans experienced after seeing acts of violence during war. Today, PTSD has a much broader definition and is used to diagnosis the broader population.

During the past two decades, many traumatic events have unfolded that have triggered PTSD in the general population. Some of these events included random bombings of well-populated buildings, such as the World Trade Center in 1993 and 2001 and the Pentagon in 2001. Events have also included natural disasters, such as the tsunami that hit India in 2004 and the landfall of Hurricane Katrina on the U.S. Gulf Coast in 2005.

Demographics

PTSD may strike persons of any age, gender, or race, although some people are more prone to develop it. For instance, eight to 41% of people who have been in an automobile accident will likely develop PTSD.

However, PTSD is more common in seniors. 13% of the senior population reports they are affected by PTSD in comparison to 10% of the entire population. It may be understood why there are 3% more instances of PTSD in seniors than in the general population: Reports of elder abuse crimes have gone up by 200% since 1986. Also, the incidence of PTSD is known to be higher in Holocaust survivors, war veterans, and cancer or heart surgery survivors, which accounts for an older percentage of the population. Lastly, experts have shown that 30 out of every 100 Vietnam Veteran have experienced PTSD at some point. And of those seniors that are veterans, there is an increasing number who are isolated and/or in poor health as a result of PTSD.

Causes and symptoms

The causes of PTSD may vary greatly from person to person, although some psychologists believe there are three factors that affect the severity of PTSD: Pre-event factors, event factors, and post-event factors. Pre-event factors are defined by a person's life experience before a traumatic event affects them, and can include the genetic makeup or exposure to previous natural disasters, childhood physical, sexual or emotional abuse, and pre-existing depression or anxiety . Event factors occur during the traumatic event, and can include the proximity to the event, what the event means to the person, or the amount of exposure. Post-event factors exist after the traumatic event takes place, and can include lack of support from others, the inability to affect or change the situation before it took place, or a lack of meaning of the event.

Symptoms may occur in less than one month or as late as several months or years later. The timeline for the onset of the symptoms determines the type of PTSD. The types are: Acute Stress Disorder, which appears in less than one month of the traumatic event; Acute PTSD, which appears in one to three months; or Chronic PTSD, which occurs at least three months after the event.

To determine whether PTSD is present, symptoms must include at least one of the following:

• recalling distressing details of the event

• night terrors
• mental or physical distress to triggers that are associated with or similar to the event

Additionally, three symptoms from the following categories must be present:

• avoiding social interaction
• choosing to forget parts or all of the event
• lack of hope or disinterest in life
• detaching or withdrawing
• feeling “numb” or unable to have a positive emotional response

Finally, two symptoms from the following categories must be present:

• inability to fall asleep or stay asleep
• lack of patience or easily irritated
• easily angered l difficulty focusing on tasks
• abnormally intense wariness of danger
• easily startled

In addition to the symptoms above, other factors may be present, including depression, anxiety/panic attacks, inability to leave one's home (agoraphobia), or alcohol or drug abuse. It is not uncommon for seniors to have depression that accompanies PTSD. However, seniors with both PTSD and depression are sometimes slower to respond to treatment and may take twelve months before showing any improvement.

Symptoms of depression in seniors may be similar to or overlap symptoms of PTSD. Some symptoms of depression in seniors may include:

• sadness and anxiety for long periods of time
• avoiding social interactions
• sleeping too many hours or disinterest in leaving their bed or waking
• inability to fall asleep or stay asleep
• crying for no visible reason
• feelings of hopelessness or emptiness
• complaining of previously-treated physical maladies
• inability to make day-to-day decisions
• grumpiness
• tiredness or fatigue
• weight loss or gain
• confusion
• feelings of guilt
• feelings of hopelessness
• thinking about or attempting suicide

Diagnosis

A mental health care provider can make a formal diagnosis of PTSD by assessing the patient's symptoms and identifying the traumatic event. It is recommended that the patient see a doctor or mental health care provider when the symptoms begin to ensure rapid treatment.

Treatment

The sooner PTSD is treated, the greater the likelihood of a positive outcome. The longer left untreated, the higher the likelihood of ongoing psychological issues as a result of PTSD.

Because of the high numbers of seniors (most especially veterans) in the United States who are isolated and/or in poor health, experts recommend routine mental health screening for seniors to improve treatment outcomes.

Nutrition/Dietetic concerns

Experts say eating a balanced diet contributes to a senior's ability to avoid illness and depression. However, dietary changes will not treat PTSD.

Medications

There are several antidepressant medications available for patients who suffer from PTSD, including citalopram (Celexa), fluoxetine (Prozak), paroxetine (Paxil), and setraline (Zoloft). Antidepressant medications increase the amount of serotonin in the brain, which experts believe reduce symptoms of depression.

Therapy

There are several therapies available to treat PTSD. While the approach may be different for each type of therapy, the goal for all of them is to reduce the symptoms of PTSD so that the senior can return to a more healthful mental state. A trained mental health care provider can assess the needs of the senior with PTSD and determine which type of therapy has the greatest likelihood of success.

Several types of therapy may include:

• Cognitive behavioral therapy—The patient works with a therapist to understand how their thoughts affect their symptoms

• Exposure therapy—The patient is “exposed” to their traumatic event by discussing it repeatedly with a therapist to desensitize them from the event
• EMDR (Eye movement desensitization and reprocessing)—A relatively new type of therapy that may affect how the patient reacts to their traumatic event by utilizing eye movement while viewing distractions.
• Individual therapy—The patient meets with a therapist in a one-on-one setting
  • Group therapy—Working with a therapist and a group of people whose goal(s) are the same as the patient's in treatment
• Family therapy—Working with a therapist and the patient's family so they may all express their feelings in a safe setting

KEY TERMS

Post-traumatic stress disorder (PTSD) —A severe psychological condition that is developed as a result to of viewing or being a part of a traumatic event.

Prognosis

PTSD in seniors is treatable when recognized. Without treatment, experts believe PTSD can be disabling in 50% of cases. It is also imperative to recognize symptoms as early as possible to begin treatment immediately so that the symptoms of PTSD do not escalate. The length of time it takes to begin treatment will likely impact the duration of the symptoms and the outcome of success.

Prevention

It is unclear whether PTSD in seniors can be prevented.

Resources

BOOKS

Williams, Mary Beth, Ph.D., LCSW, CTS; Poijula, Soili, Ph.D. The PTSD Workbook: Simple, Effective Techniques for Overcoming Traumatic Stress Symptoms. New Harbinger Publications, Inc., 2002.

PERIODICALS

Robert Wood Johnson Foundation. “Impact of Comorbid Panic and Posttraumatic Stress Disorder on outcomes of Collaborative Care for Late-Life Depression in Primary Care.” The American Journal of Geriatric Psychiatry, 13(1) (January 2005): 48-58.

OTHER

Burton, John, M.D. “Case Studies: Post Traumatic Stress Disorder.” Johns Hopkins Medicine, The Geriatric Education Center Online 2008. http://www.hopkinsmedicine.org/gec/studies/ptsd.html; (2008).

“Depression and the Elderly.” AnxietyBC. 2007. http://www.index.va.gov/search/va/va_search.jsp?QT=depression+and+the+elderly; (2007).

“National Center for PTSD Fact Sheet.” U.S. Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder. 2008. http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_treatmentforptsd.html; (2008).

National Institute of Mental Health (NIMH). “Post-Traumatic Stress Disorder, A Real Illness.” 2008. http://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-research-fact-sheet.shtml#intro; (March 2, 2001).

“Post Traumatic Stress Disorder.” AnxietyBC. 2008. http://www.anxietybc.com/resources/ptsd.php; (2008).

“Post-traumatic stress disorder in Elderly Veterans: Results from a Multi-site Study (PRISMe).” U.S. Department of Veterans Affairs, Health Services Research & Development Service (HSR&D). 2002. http://www.hsrd.research.va.gov/meetings/2002/1142.htm; (2002).

ORGANIZATIONS

AnxietyBC, 4th Floor, 402 East Columbia Street, New Westminster, BC, V3L 3X1, Canada, 604-681-3400, anxietybc.com.

National Council on Aging, 1901 L Street, NW, 4th Floor, Washington, DC, 20036, 202-479-1200, http://www.Ncoa.org.

National Institute of Mental Health (NIMH), 6001 Executive Boulevard, Rockville, MD, 20852, 301-443-4513, 301-443-4279, http://www.nimh.nih.gov/index.shtml.

United States Department of Veterans Affairs, 100 Emancipation Drive, Hampton, VA, 23667, 757-722-9961, http://www.va.gov.

Lauren L. Stinson