Lely J C G Knipscheer J W Moerbeek M Ter Heide F J J Van Den Bout J & Kleber R J Randomised Controlled Trial Comparing Narrative Exposure Therapy With Present
Lely, J. C. G., Knipscheer, J. W., Moerbeek, M., ter Heide, F. J. J., van den Bout, J., & Kleber, R. J. . Randomised controlled trial comparing narrative exposure therapy with present-centred therapy for older patients with post-traumatic stress disorder. British Journal of Psychiatry, 214, 369377.
Special Considerations For Assessment And Treatment
The Role of Comorbidities
The classification, assessment, and treatment of PTSD may differ by age, in part, due to the complexity and comorbidity present in older adults. Individuals with PTSD are at particular risk for poor health, disability , and accelerated aging such as early occurrence of medical problems, premature signs of biological aging, and premature mortality . Numerous mechanisms for this association and accelerated aging have been proposed. These include cardiometabolic risk factors and inflammatory processes . Generally speaking, PTSD is related to worse health across many organ systems . As a group, individuals with PTSD have higher rates of medical care utilization , hospitalizations , and earlier mortality . Medication management of PTSD and comorbid disorders in late life is complex, and although beyond the scope of this review, needs to be carefully applied and monitored.
Cognitive changes.
Perhaps one of the most complex issues in considering multi-morbidity and treatment of late-life PTSD is the issue of comorbid cognitive impairment. PTSD is associated with alterations in neurocognitive functioning at the behavioral and neural level , including impairments in verbal learning, speed of information processing, attention/working memory, verbal memory, and executive function . These associations are seen across the age range , but appear to be stronger in older adults.
Sensory changes: hearing and vision.
Pain.
Psychiatric conditions.
Do I Have A Stress Disorder Or Is It Really Ptsd
PTSD falls into the category of stress disorders in the diagnostic statistical manual, and both of them are mental health disorders. Not everyone that experiences a traumatic event develops PTSD or needs treatment. Other types of traumatic stress can occur without becoming PTSD. You can also have a different type of PTSD called Complex PTSD.
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Pietrzak R H Goldstein R B Southwick S M & Grant B F Psychiatric Comorbidity Of Full And Partial Posttraumatic Stress Disorder Among Older Adults In The United States: Results From Wave 2 Of The National Epidemiologic Survey On Alcohol And Related Conditions American Journal Of Geriatric Psychiatry 20 380390
Pietrzak, R. H., Goldstein, R. B., Southwick, S. M., & Grant, B. F. . Psychiatric comorbidity of full and partial posttraumatic stress disorder among older adults in the United States: Results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. American Journal of Geriatric Psychiatry, 20, 380390.
Can You Have Ptsd And Not Know It
You can absolutely have post-traumatic stress disorder and not know it. PTSD is a very undiagnosed mental illness. Some people think you can only develop PTSD if you are a combat veteran. Although many combat veterans do develop PTSD, anyone can. You can develop PTSD from abuse from family members, watching the effects of substance abuse in your family as a child, seeing a parent go through suicidal thoughts or an attempt, and emotionally abusive relationships.
Read more about PTSD and its symptoms on the American Psychiatric Associations site.
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Lohr J B Palmer B W Eidt C A Aailaboyina S Mausbach B T Wolkowitz O M Thorp S R & Jeste D V Is Post
Lohr, J. B., Palmer, B. W., Eidt, C. A., Aailaboyina, S., Mausbach, B. T., Wolkowitz, O. M., Thorp, S. R., & Jeste, D. V. . Is post-traumatic stress disorder associated with premature senescence? A review of the literature. American Journal of Geriatric Psychiatry, 23, 709-725.
Outcome: Trajectory Across Therapy
Pre- and post-treatment data suggest an overall positive response to GCBT. Scores collected throughout the course of treatment provide a detailed picture of how these changes occurred. Consistent with low levels of initial symptomology, Matthews IES-R and BDI-II data indicate a fairly flat treatment response . Matthew was perhaps the most verbally engaged of the three older adults in this group and was generally compliant with homework assignments. Because his symptoms of avoidance were relatively minor in comparison to those of John and David, he moved quickly through his fear hierarchy. Matthews success on these assignments was encouraging, but care was taken to prevent other members from judging their own progress as inadequate by comparison. Matthew did struggle with the MVA narrative, and processing emotions associated with the fatality required several sessions. He seemed the most adept at mastering the cognitive techniques, however, and used these tools to challenge feelings of guilt and self-blame. As indicated by his scores at post-assessment, Matthew continued to utilize skills obtained in group, and his IES-R and BDI-II scores were negligible at the post-assessment.
Fig. 1a. IES-R scores across treatment for case group Missing data points represent missed sessions
Fig. 1b. BDI-II scores across treatment for case group Missing data points represent missed sessions
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Unique Obstacles For Older Adults
The biggest obstacle for older adults agreeing to treatment is in convincing them that the stress and anxiety they are trying to cope with can actually be treated. Many do not trust psychological treatment because in their youth it was not as reputable as it is today.
Unfortunately, even if older adults begin psychological treatment, there are other physical hurdles that can slow their progress.
Ongoing research is making a connection between untreated PTSD and early aging. Its not quite clear how these two issues are connected, but early results indicate adults who fail to treat their post-traumatic stress may experience dementia and other cognitive impairments at a younger age than adults without PTSD, and they may be more susceptible to stress-induced weight gain, gastric ulcers and type 2 diabetes. More research is needed.
No matter how long you or a loved one may have keptpost-traumatic stress hidden, its never too late to get treatment. A licensed professional can help you take control of the mental, emotional and physical symptoms of PTSD.
Impact Of Advanced Age On Outcome & Process
A number of important points should be noted given the criticisms of cognitive-behavioral interventions with older trauma survivors. In-group discussion and review of weekly homework indicated no greater difficulty with exposure or cognitive-based interventions than members in the larger Beck et al. clinical trial. All three men participated in weekly, between-session exposure exercises with no evidence of physical complications. These results are consistent with previous case studies suggesting the efficacy of exposure therapy among older trauma survivors . Admittedly, the men in this group evidenced few acute health concerns to be aggravated by exposure-related arousal. case study, however, demonstrates that exposure therapy can be effectively adapted even among older individuals with substantial health issues. An important commonality between Markowitz approach and the current group protocol is that both emphasized controlled, graduated exposure. In contrast with other methods , the present exposures were conducted at a pace dictated by the client while maintaining therapeutic effects. This graded approach may allow older trauma survivors to capitalize on the well-documented benefits of exposure therapy while avoiding the risk of undue physiological burden that may accompany more extreme variations of exposure.
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Thorp S R Sones H M & Cook J M Posttraumatic Stress Disorder Among Older Adults In K H Sorocco & S Lauderdale Cognitive Behavior Therapy With Older Adults: Innovations Across Care Settings New York Ny: Springer Publishing Company
Thorp, S. R., Sones, H. M., & Cook, J. M. . Posttraumatic stress disorder among older adults. In K. H. Sorocco & S. Lauderdale , Cognitive behavior therapy with older adults: Innovations across care settings . New York, NY: Springer Publishing Company.
Psychotherapy For Ptsd In Older Adults
Randomized Clinical Trials of Psychotherapy for PTSD in Older Adults
Almost all randomized controlled trials of psychotherapy for adult patients with PTSD do not include older adults or include them in sufficient numbers to make age comparisons. A recent systematic review of psychological treatment for trauma in studies with samples of at least 50% adults aged 55 and older identified 20 studies, only two of which were randomized trials two additional RCTs were published since then . None of these published RCTs have tested the efficacy of Prolonged Exposure, Cognitive Processing Therapy, or Eye Movement Desensiti zation Reprocessingevidence-based psychotherapies for PTSD in older trauma survivors.
This is not to suggest that these EBPs for PTSD are not effective for older adults. Instead, we note that there are insufficient randomized trials with adequate raw numbers and representative proportions of older adults across the late life span to be able to conclude definitively that these treatments are effective for older adults based on clinical trial data alone. By comparison, there is a larger clinical trial literature focusing on psychotherapy for late-life depression that establishes efficacy of various treatment approaches and drills down on specific accommodations relevant to older adults that maximize effectiveness in older populations . Such a body of literature has yet to be developed for late-life PTSD.
Case Reports of Psychotherapy for PTSD in Older Adults
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Ptsd Symptoms & Signs
The symptoms of post-traumatic stress disorder in adults may occur immediately after the event, or they can emerge at some time later. Many people tend to connect posttraumatic stress disorder in adults with flashbacks after a traumatic event, but theres more to PTSD than that. Certain situations may trigger your senses, and they can cause you to become stressed and hypervigilant. You may feel detached too. You may have constant negative thoughts about yourself or the trauma that occurred. It may be difficult to feel any positive emotions. Other mental disorders can also be concurrent with post-traumatic stress disorder. Even further, PTSD causes physical symptoms or physical sensations in many people, not just mental health problems.
Well-meaning family members and friends sometimes try to help by pressuring you to just get over it. They dont often understand that exposure to a traumatic event is a serious issue that often requires professional help. Sometimes, the family members are the reason for your PTSD symptoms, especially if you went through childhood abuse or have a family history of substance use.
How Does Ptsd Affect The Elderly
According to the National Institutes of Health, 50% to 90% of older adults in the U.S. have been exposed to at least one type of potentially traumatic event. Not every exposure to a traumatic event will cause the condition, but PTSD in the elderly is often underreported.
PTSD in the elderly doesnt just affect their mental wellness. People who have experienced trauma or have PTSD have higher rates of many physical health conditions, including cardiovascular disease, hypertension, coronary artery disease, osteoarthritis, and diabetes.
An added complication unique to the elderly population is how PTSD interacts with memory issues. Seniors who experience memory issues may go long stretches where they forget about past trauma, only to have it resurface again. Seniors suffering from PTSD and memory issues may benefit greatly from in-home memory care.
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Biological And Pharmacological Treatment Of Post
Ryan C. Hall, MD1,2 Richard C. Hall, MD1,2
1Department of Psychiatry and Behavioral Medicine, University of South Florida, Tampa, FL
2Department of Medical Education, University of Central Florida, Orlando, FL
Abstract: This article focuses on the current state of treatment for post-traumatic stress disorder , with an emphasis on meeting the needs of older adults and elderly persons who are in the early stages of PTSD or who have chronic PTSD. The authors review some of the pre-disaster and post-disaster interventions that clinicians can employ if older patients present with early signs and symptoms of PTSD. The authors discuss how concepts such as disaster immunization, resilience, and psychological first aid affect treatment of PTSD. In some patients, use of medication to treat the symptoms of PTSD may be necessary. This article gives an overview of the considerations and evidence to guide safe and appropriate prescribing of a pharmacologic agentnamely antidepressants and benzodiazepinesto treat the symptoms of PTSD. The final article in the series will discuss psychotherapeutic approaches to treat PTSD.
Key words: Post-traumatic stress disorder, psychological first aid, disaster immunization, disaster inoculation, acute stage of trauma.________________________________________________________________________________________________________________________________
Treating PTSD With Pre-disaster and Post-disaster Interventions
Pharmacological Management of PTSD
Case Example Of Group Cbt With Older Adults
To illustrate therapeutic process of CBT in older adults, we present data collected within the context of a cognitive-behavioral group intervention targeting motor-vehicle accident related PTSD . Specifically, we provide a series of case studies taken from a treatment group containing a subset of three older gentlemen. A number of points should be emphasized in outlining these vignettes:
Although the present data were not collected as part of a systematic study examining treatment outcome in older trauma survivors, they do provide a unique opportunity to explore therapeutic process in older adults participating in structured group CBT. Several authors suggest that interpersonal relationships developed within the context of group therapy may be especially beneficial in the treatment of PTSD . Examples of case studies detailing group interventions for PTSD among elderly clients are available in the existent literature, but these reports are limited largely to supportive group therapies for aging combat veterans . Examining process and treatment outcome in response to a structured, cognitive-behavioral group intervention extends the existing case literature.
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Ptsd In Older Adults: Other Medical Problems
You may be wondering, what types of health conditions occur in higher rates among older survivors of trauma? Falls are one thing to worry about. Sometimes older adults with PTSD may have a tendency to drift off, or their mind may wander. As a result, falls are a concern. Falls can be a PTSD exacerbation and can actually make the PTSD worse, making symptoms even stronger. Making sure that there are slip guards and other safety precautions in place is a must for someone who already has had traumatic experiences. People often ask, can PTSD cause dementia? The short answer is no. However, PTSD symptoms, if untreated, can contribute to poor cognitive health, which can increase dementia symptoms. Those who suffer from PTSD should seek counseling or treatment, or help via support groups if possible. Service dogs are also a good option for PTSD in older adults and the elderly.
To find out more about what help is available for PTSD in older adults, or to learn about mobility products and safety products that can help prevent falls and promote mobility, contact us at Williams Lift Co. today. We want both caregivers and their patients or loved ones to live their best lives.
What Are The 5 Signs Of Ptsd
Some of the biggest signs of a traumatic stress disorder are struggling with substance use, difficulty finding an effective treatment for symptoms, hypervigilance, anxiety, and emotional issues. Other mental health problems are commonly diagnosed before PTSD, even when it is the main issue. You may be diagnosed with a mental health condition that doesnt seem to fit you at all, and it can take time to find PTSD treatment that works.
If youve found that your current health care providers dont take you seriously, or youre not feeling that youre getting your PTSD treated, it might be time to look into other treatments to manage symptoms.
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Posttraumatic Stress Symptoms Among Older Adults: A Review
Anica Pless Kaiser, PhD, Jennifer Schuster Wachen, PhD, Carrie Potter, BA, Jennifer Moye, PhD, & Eve Davison, PhD, with the Stress, Health, and Aging Research Program
Demographic patterns across the globe are changing, and older people constitute a growing proportion of the population. Although many older adults enjoy well-being and satisfaction in later years, some experience psychiatric and mental health difficulties. A topic of particular significance to professionals working with older adults, both Veteran and non-Veteran, is the understanding, assessment, and treatment of posttraumatic stress, as posttraumatic stress symptoms can emerge or re-emerge late in life.
Age-related factors can interact with psychiatric symptoms and carry implications for research and clinical care. For clinicians, see PTSD Assessment and Treatment in Older Adults for recommendations.
In This Article
How Is Ptsd Treated In The Elderly
Treatment options should always be developed in consultation with medical professionals. PTSD is often treated with therapy and there are therapists who specialize in it. A good care plan that includes evaluation and regular appointments with a qualified therapist might be a better direction to take this.
Step 1: Assessment
The first step in treating PTSD in the elderly is assessment. A mental health professional can thoroughly examine an elderly person to uncover the root cause of their PTSD, what can trigger PTSD symptoms in them, and the best treatment options. A thorough examination often includes a physical exam, a mental health exam, and even an in-home assessment to help inform treatment plans.
Step 2: Therapy
Several types of therapy are highly effective in treating the symptoms of PTSD and teaching seniors how to manage the disorder. Cognitive therapy is a type of talk therapy that can help seniors recognize their thinking patterns and change them to better cope with their symptoms.
Exposure therapy exposes seniors to past trauma to help them safely face situations they find triggering. General stress management therapy can also be an effective way to manage symptoms and learn what to do when PTSD is triggered.
Step 3: Medication
While not appropriate for all seniors, certain medications have been proven to alleviate the symptoms of PTSD. Anti-depressants can help with feelings of depression and anxiety and also improve sleep problems and issues with concentration.
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