Elsevier

Journal of Anxiety Disorders

Volume 14, Issue 2, March–April 2000, Pages 133-156
Journal of Anxiety Disorders

Posttraumatic Stress Disorder in Older Adults: A Conceptual Review

https://doi.org/10.1016/S0887-6185(99)00045-6Get rights and content

Abstract

—Issues that are salient in understanding posttraumatic stress disorder (PTSD) in older adults are examined in this review. Although this issue has received scattered attention in the literature since introduction of the diagnosis of PTSD to the Diagnostic and Statistical Manual (DSM) in 1980, it is clear that numerous conceptual and defining questions exist in our understanding of the aftermath of trauma exposure in older adults. In approaching this issue, studies pertaining to diagnostic status as well as broader dimensions of psychosocial functioning are examined. Concerns that are unique to older adults are highlighted throughout, with particular attention to areas where additional research is warranted.

Section snippets

Posttraumatic stress disorder: diagnostic criteria and cardinal features

Posttraumatic stress disorder is initiated by exposure to extraordinarily stressful life events, such as military combat, violent personal assault, being taken hostage, natural or manmade disasters, and severe car accidents. The specific symptoms of PTSD are described in Table 1 and fall into three categories: (a) reexperiencing symptoms, (b) avoidance and numbing symptoms, and (c) increased physiologic arousal. Although there have been changes in the specific symptoms demarcated as comprising

What are the unique symptoms of posttraumatic stress disorder in older adults?

Because criteria for the diagnosis of PTSD largely have been defined based on symptoms reported by younger adults, it is important to examine the unique features of this disorder that are reported by older adults. The studies on this topic are reviewed in two groups: reports of PTSD symptoms in older individuals who were traumatized in young adulthood and those studies examining the sequelae of trauma occurring in later life.

Most older adults who were traumatized earlier in their life report an

Prevalence of posttraumatic stress disorder in older adults

Given the mixed collection of findings concerning PTSD symptom profiles in older adults, it is not surprising that prevalence estimates likewise vary. Prevalence data are based primarily on three groups of survivors: war veterans, Holocaust survivors, and victims of recent disasters. Although there is the suggestion that prevalence rates of PTSD—like all anxiety disorders—decline with advancing age (Regier et al., 1988), it is important to examine these data more closely, particularly in light

Can posttraumatic stress disorder begin many years after trauma exposure in older adults?

Delayed-onset PTSD is an infrequently diagnosed variant of the disorder, despite its recognition in each version of the DSM. This syndrome has been most commonly examined among Vietnam war veterans (Watson, Kucala, Manifold, Vassar, & Juba, 1988), although recently, increased attention has been devoted to this topic in the elderly (Sleek, 1998). Herrmann and Eryavec (1994) described two older men who met the criteria for delayed-onset PTSD. In one, the onset of PTSD symptoms was associated with

What comorbid features are associated with posttraumatic stress disorder in older adults?

Apart from having a diagnosis of PTSD, older traumatized individuals are likely to experience additional psychiatric diagnoses, including major depression, other anxiety disorders, somatic conditions, cognitive disturbances, and alcoholism. This issue has received particular attention among veterans. In these individuals, notable rates of lifetime major depression (37%) and alcohol abuse (53%) have been reported (Herrmann & Eryavec, 1994). In a study of 140 community-dwelling WW II and Korean

What are the radiating effects of exposure to trauma on the elderly?

In addition to a recent focus on the prevalence and symptom patterns of PTSD in older adults, a larger body of literature exists that examines related features of trauma exposure among older persons. These writings approach this issue from a nonpsychiatric perspective, emphasizing clinical features, physical consequences, and social-psychological aspects of trauma exposure. This diverse collection of writings is reviewed in this section, with particular emphasis on what these sources tell us

Summary

In reviewing the literature on PTSD in older adults, one is struck by the many questions that remain unanswered. It is clear that PTSD does occur in the elderly and can be diagnosed using the DSM criteria, which were derived from studies involving younger samples. Specific symptom profiles may differ in the older adult, particularly in those individuals with chronic PTSD. These potential differences could lead to misdiagnosis of PTSD in the elderly, an outcome that would impact derivation of

Acknowledgements

The authors thank Shirley Michelson for her assistance in preparation of the tables.

Supported in part by National Institutes of Mental Health grant MH53932 (M. Stanley and J. G. Beck).

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