Psychological trauma in older adults

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Psychological trauma in adultswho are older (usually more than 60 years), [1] is the overall prevalence and occurrence of trauma symptoms within the older adult population. (The term psychological trauma is sometimes hereinafter referred to as trauma). This should not be confused with geriatric trauma. Although there is a 90% likelihood of an older adult experiencing a traumatic event, [2] there is a lack of research on trauma in older adult populations. This makes research trends on the complex interaction between traumatic symptom presentation and considerations specifically related to the older adult population (e.g., the aging process, a lifetime prevalence of traumatic symptoms [otherwise known as lifetime trauma], etc.) difficult to pinpoint. [2] [3] [4] [5] [6] [7] This article reviews the existing literature and briefly introduces various ways, apart from the occurrence of elder abuse, that psychological trauma impacts the older adult population.

Contents

Presentation

Psychological trauma in older adults can present differently depending on the type of traumatic experience and when it took place. [8] If the traumatic experiences of an older adult were recurrent in childhood (see childhood trauma or complex trauma) or in adulthood, the experiences can have varying but lasting detrimental effects on an older adult's psychological well-being, [6] [8] health, [2] [9] [10] and cognition. [9] [10]

Older adults who experienced childhood-based trauma have a long-term trauma history, which increases their likelihood of experiencing more severe negative psychological, health, and cognitive symptoms. [9] [10] [11] Additionally, the timing of trauma exposure has the potential to influence both the manifestation of post-traumatic stress disorder (PTSD) symptoms and the psychosocial functioning of older adults. Generally, older adults who identify their most distressing traumatic event as occurring during childhood tend to exhibit more severe symptoms of PTSD and report reduced subjective happiness compared to older adults who have experienced trauma later in life. [12] A specific example is the intersection between recurrent interpersonal trauma and PTSD symptoms as an older adult. Research suggests that this intersection in older adults can lead to a perpetuating cycle where both components contribute to the experience of chronic pain later in life. [13]

Adulthood-based trauma considerations introduce the complexity of the interaction between an older adult's trauma presentation and potential neurocognitive components. [3] Research indicates that older adults who have had PTSD are more likely to develop dementia than those who did not have PTSD. [3] [14] The neurocognitive effects of PTSD symptoms can also look similar to the neurocognitive effects of cognitive impairment in older adults. [3]

Psychological trauma diagnosis in older adults is considered less common than in younger adults. [3] [8] [9] However, older adults' symptom presentations may make it more difficult for healthcare providers to identify trauma as the cause of an individual's symptoms (e.g., if the individual exhibits somatic representations of trauma symptoms; see psychosomatic disorders). [3] [8] [9] [11] Some older adults may be more likely to report non-psychological symptoms and may not be aware that they may be experiencing trauma symptoms. [3] Some trauma symptoms may emerge later on in life (known as Late-Onset Stress Symptomatology), [11] which could make pinpointing a potential cause even more difficult. [11] [15] Considering cohort factors is also important. [16] The majority of today's older adults grew up during a time when psychological trauma was just starting to be acknowledged. [16] This can make identifying and treating trauma within this population more difficult because there may be a lack of awareness or willingness to perceive their symptoms from a different perspective. [10] [11]

Older adults who experienced trauma in their later years may also retain harmful symptoms associated with the normal aging process (see old age). [17] For example, there are several research studies on older adults potentially developing PTSD after experiencing a fall. [17] As people get older, they tend to experience more falls, leading to a fear of falling. [18] A meta-analysis of these studies revealed that female older adults who were more frail had a greater likelihood of developing PTSD following a fall, compared to older adults who were less frail and had higher levels of psychological resilience. [17] Older adults' past experiences paired with current perceptions and health conditions are likely to perpetuate various psychological disorders (i.e., depression, anxiety, and phobias related to older adult considerations such as falling) [18] [14] as well as worsen existing PTSD symptoms. [3]

Research

Research on psychological trauma in older adults is sparse, [3] [4] [5] [6] [13] with some individual studies lacking empirical reliability and validity. [7] In order to assess and treat psychological trauma in older adults, strong research is needed within scientific literature. This will help in creating psychological screeners for trauma, which can aid in differentiating trauma symptom from other health or psychological disorders. [7] Trauma symptoms can manifest differently among older adults. While there isn't a PTSD screener specifically designed for the general older adult population, certain PTSD screeners have been successfully tested with veteran older adults and can effectively screen for PTSD. [3]

In fact, most of the research on psychological trauma in older adults stems from the veteran population. [8] [11] [14] PTSD in the older adult veteran population is a focal point of research with Veterans Affairs (VA; see Veterans Health Administration). The VA has been considered a leader in trauma research for decades. [19] Considering that the concept of trauma originated with soldiers' experiences in war (i.e., trauma was labelled as "shell shock" or "war neurosis"), [16] the VA closely monitors trauma development and treatment for veterans of all ages and identities. [20] The results with aging veterans highlights the need to further understand psychological trauma within older adults more generally, including how it impacts their quality of life. [11]

Research on trauma in older adults is relevant and applicable in clinical settings as well. The National Center for PTSD (NCPTSD) [19] conducts clinical research through the VA by implementing and providing psychological treatment for veterans who have experienced trauma. [21] This includes research into such treatments as cognitive processing therapy (CPT), eye movement desensitization reprocessing (EMDR), and prolonged exposure therapy (PE). [9] [21] The NCPTSD claims these three therapeutic orientations have a 53% success rate in PTSD symptom remission. [19] Although research indicates that exposure therapies generally show effectiveness for treating trauma in older adults, [7] [9] PE has been specifically identified as a reliable therapeutic approach for this population. [9] If an older adult has both psychological trauma and cognitive impairment, it is recommended to provide them with an adapted or modified version of an evidence-based therapeutic treatment. [3] If an older adult with psychological trauma is considering taking medication concurrently with and as a supplement for therapy, the VA has identified four medications for PTSD treatment: fluoxetine, paroxetine, sertraline, and venlafaxine. [19] While there is limited research on medication specifically for treating trauma in older adults, medication use in general (see pharmacotherapy) can be beneficial for psychological and health treatment. [18] It is crucial to monitor medication half-lives and potential harmful interactions when taking multiple medications. [18]

Related Research Articles

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

Psychological trauma is an emotional response caused by severe distressing events such as accidents, violence, sexual assault, terror, or sensory overload.

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that is controversial within the psychological community. It was devised by Francine Shapiro in 1987 and originally designed to alleviate the distress associated with traumatic memories such as post-traumatic stress disorder (PTSD).

Complex post-traumatic stress disorder (CPTSD) is a stress-related mental disorder generally occurring in response to complex traumas, i.e. commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.

Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder. It is characterized by two main treatment procedures – imaginal and in vivo exposures. Imaginal exposure is repeated 'on-purpose' retelling of the trauma memory. In vivo exposure is gradually confronting situations, places, and things that are reminders of the trauma or feel dangerous. Additional procedures include processing of the trauma memory and breathing retraining.

<span class="mw-page-title-main">Military sexual trauma</span> U.S. legal term for sexual assault or harassment during military service

As defined by the United States Department of Veterans Affairs, military sexual trauma (MST) are experiences of sexual assault, or repeated threatening sexual harassment that occurred while a person was in the United States Armed Forces.

Memory and trauma is the deleterious effects that physical or psychological trauma has on memory.

Cognitive processing therapy (CPT) is a manualized therapy used by clinicians to help people recover from posttraumatic stress disorder (PTSD) and related conditions. It includes elements of cognitive behavioral therapy (CBT) treatments, one of the most widely used evidence-based therapies. A typical 12-session run of CPT has proven effective in treating PTSD across a variety of populations, including combat veterans, sexual assault victims, and refugees. CPT can be provided in individual and group treatment formats and is considered one of the most effective treatments for PTSD.

Jon Elhai is a professor of clinical psychology at the University of Toledo. Elhai is known for being an expert in the assessment and diagnosis of Posttraumatic stress disorder (PTSD), forensic psychological assessment of PTSD, and detection of fabricated/malingered PTSD; as well as in internet addictions.

Because of the substantial benefits available to individuals with a confirmed PTSD diagnosis, which causes occupational impairment, the distinct possibility of false diagnoses exist, some of which are due to malingering of PTSD. Malingering of PTSD consists of one feigning the disorder. Post-traumatic stress disorder (PTSD) is an anxiety disorder that may develop after an individual experiences a traumatic event. In the United States, the Social Security Administration and the Department of Veterans Affairs each offer disability compensation programs that provide benefits for qualified individuals with mental disorders, including PTSD. Malingering can lead to a decline in research and subsequent treatment for PTSD as it interferes with true studies. Insurance fraud may also come about through malingering, which hurts the economy.

The Trauma Symptom Inventory (TSI) is a psychological evaluation/assessment instrument that taps symptoms of Posttraumatic stress disorder and other posttraumatic emotional problems. It was originally published in 1995 by its developer, John Briere. It is one of the most widely used measures of posttraumatic symptomatology.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

<span class="mw-page-title-main">Post-traumatic stress disorder among athletes</span> Prevalence of PTSD among athletes

Posttraumatic stress disorder (PTSD) is a cognitive disorder, which may occur after a traumatic event. It is a psychiatric disorder, which may occur across athletes at all levels of sport participation.

<span class="mw-page-title-main">Child PTSD Symptom Scale</span>

The Child PTSD Symptom Scale (CPSS) is a free checklist designed for children and adolescents to report traumatic events and symptoms that they might feel afterward. The items cover the symptoms of posttraumatic stress disorder (PTSD), specifically, the symptoms and clusters used in the DSM-IV. Although relatively new, there has been a fair amount of research on the CPSS due to the frequency of traumatic events involving children. The CPSS is usually administered to school children within school boundaries, or in an off-site location to assess symptoms of trauma. Some, but not all, people experience symptoms after a traumatic event, and in serious cases, these people may not get better on their own. Early and accurate identification, especially in children, of experiencing distress following a trauma could help with early interventions. The CPSS is one of a handful of promising measures that has accrued good evidence for reliability and validity, along with low cost, giving it good clinical utility as it addresses a public health need for better and larger scale assessment.

Trauma-sensitive yoga is yoga as exercise, adapted from 2002 onwards for work with individuals affected by psychological trauma. Its goal is to help trauma survivors to develop a greater sense of mind-body connection, to ease their physiological experiences of trauma, to gain a greater sense of ownership over their bodies, and to augment their overall well-being. However, a 2019 systematic review found that the studies to date were not sufficiently robustly designed to provide strong evidence of yoga's effectiveness as a therapy; it called for further research.

Post-traumatic stress disorder (PTSD) can affect about 3.6% of the U.S. population each year, and 6.8% of the U.S. population over a lifetime. 8.4% of people in the U.S. are diagnosed with substance use disorders (SUD). Of those with a diagnosis of PTSD, a co-occurring, or comorbid diagnosis of a SUD is present in 20–35% of that clinical population.

<span class="mw-page-title-main">Post-traumatic stress disorder after World War II</span>

Post-traumatic stress disorder (PTSD) results after experiencing or witnessing a terrifying event which later leads to mental health problems. This disorder has always existed but has only been recognized as a psychological disorder within the past forty years. Before receiving its official diagnosis in 1980, when it was published in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-lll), Post-traumatic stress disorder was more commonly known as soldier's heart, irritable heart, or shell shock. Shell shock and war neuroses were coined during World War I when symptoms began to be more commonly recognized among many of the soldiers that had experienced similar traumas. By World War II, these symptoms were identified as combat stress reaction or battle fatigue. In the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I), post-traumatic stress disorder was called gross stress reaction which was explained as prolonged stress due to a traumatic event. Upon further study of this disorder in World War II veterans, psychologists realized that their symptoms were long-lasting and went beyond an anxiety disorder. Thus, through the effects of World War II, post-traumatic stress disorder was eventually recognized as an official disorder in 1980.

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<span class="mw-page-title-main">Narrative exposure therapy</span>

Narrative Exposure Therapy (NET) is a short-term psychotherapy used for the treatment of post-traumatic stress disorder and other trauma-related mental disorders. It creates a written account of the traumatic experiences of a patient or group of patients, with the aim of recapturing self-respect and acknowledging the patient's value. NET is an individual treatment, NETfacts is a format for communities.

References

  1. ↑ "Identifying Vulnerable Older Adults and Legal Options for Increasing Their Protection During All-Hazards Emergencies" (PDF). www.cdc.gov. Retrieved 12 September 2023.
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  12. ↑ Ogle, Christin M.; Rubin, David C.; Siegler, Ilene C. (November 2013). "The impact of the developmental timing of trauma exposure on PTSD symptoms and psychosocial functioning among older adults". Developmental Psychology. 49 (11): 2191–2200. doi:10.1037/a0031985. ISSN   1939-0599. PMC   3806884 . PMID   23458662.
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  19. 1 2 3 4 "Posttraumatic Stress Disorder (PTSD)". www.research.va.gov. 2021. Retrieved 20 October 2021.
  20. ↑ "Veterans Posttraumatic Stress Disorder (PTSD) - Office of Public and Intergovernmental Affairs". www.va.gov. Retrieved 20 October 2021.
  21. 1 2 "PTSD Treatment Basics - PTSD: National Center for PTSD". www.ptsd.va.gov. Retrieved 20 October 2021.
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