The following entry is from our friends at Senior Living.
Our friends at Sleep Advisor have also provided a Complete Guide to Sleeping for Soldiers and Veterans that you can read here.
Post-traumatic stress disorder, also known as PTSD, can happen to people of all ages. It is especially a common issue among aging adults because they have a more likely chance to have experienced at least one traumatic event in their lifetime. Examples of traumatic events that could lead to PTSD include military combat, a bad car accident, the unexpected death of a loved one, serious illness or injury to self or someone close, and sexual assault, to name a few.
This guide will account for PTSD among aging adults, veterans, and older homeless people. See what experts have to say about the subject, and learn more about the causes and symptoms of PTSD and how the condition can be treated.
Disclaimer: We are not doctors. This is for informational purposes only. As always, we suggest speaking to a medical professional to determine how to best address your specific situation.
Expert Perspective on PTSD Among Seniors
What is Post-Traumatic Stress Disorder (PTSD)?
PTSD is a mental problem that can take a toll on a person’s health and well-being in the long run. People usually develop PTSD after experiencing or witnessing a life-threatening event, like military combat, a natural disaster, sexual assault, or a car accident, for example. It is totally normal to feel on edge, have trouble sleeping, or have upsetting memories after a traumatizing event initially. In fact, at first, it may be a challenge to go about everyday life, like going to work, completing everyday chores, or spending time with loved ones. The good news is, most people start to feel better after a few weeks or months. If it persists for too long, then it’s time to get evaluated for possible PTSD. Some people may find symptoms of PTSD coming and going as they age as well.
PTSD develops in approximately 1 in 3 people who go through serious trauma. Normally, the condition is not related to situations that are just upsetting, like job loss, failing exams, or divorce. Instead, it results from traumatic experiences, such as:
- Personal assaults like robbery and sexual assault
- Serious illness or injury
- Unexpected death of a loved one or close friend
- Natural disasters like earthquakes, tsunamis, & floods
- Military combat
- Being held hostage
- Car accidents
- Terrorist attacks
- Sexual abuse, violence, or severe neglect
- Diagnosis of a life-threatening condition
- Witnessing violent deaths
Who’s at Risk?
Luckily, not everyone develops PTSD after a distressing event. It is not fully understood why some people get it while others don’t. However, people who have dealt with depression in the past or have anxiety are more likely to develop it. Those who don’t have a strong support system from family and friends are also at a higher risk. Genetics also plays into it to an extent. For example, if you were raised by a parent with a mental health problem, you may have a higher chance of developing PTSD in your lifetime.
Various symptoms may manifest in those who suffer from PTSD. Some of the most prevalent ones include:
- Feeling on guard all the time
- Having angry outbursts or feeling irritated a lot
- Having nightmares, flashbacks, and vivid memories of distressing event
- Getting upset by things that remind you of the traumatic experience
- Experiencing difficulty sleeping
- Feeling emotionally distant from people
- Being easily startled
- Feeling guilt, shame, or self-blame
- Losing interest in things you used to care about
- Experiencing difficulty concentrating
- Exhibiting reckless, aggressive, or self-destructive behavior
- Experiencing intense physical reactions to reminders of traumatic event such as rapid breathing, nausea, sweating, muscle tension, and pounding heart
- Noticing increased blood pressure
These common symptoms will often affect the way someone with PTSD lives life. For example, people may:
- Overwork themselves to keep their mind and body occupied
- Consistently use drugs or drink to numb feelings and “escape reality”
- Isolate themselves from society
- Think about suicide or harming others
- Avoid people, places, or things that may remind you of the traumatic event
PTSD & Aging Veterans
Military experience is not something easily forgotten. It is life-changing. In fact, many aging veterans still have vivid memoriesof their combat experiences, which can negatively affect their lives even many years after war. After retiring, symptoms of PTSD may become more prevalent for various reasons such as:
- Having more time and fewer things to keep you busy, and thus, you’re more likely to think back on memories
- Hearing bad news on media may bring back bad memories
- Getting diagnosed with medical issues, resulting in feeling weak and helpless
- Coping with stress the unhealthy way like using substances or alcohol more often, which could lead to serious health problems
Some veterans don’t experience symptoms of PTSD immediately. The common patterns for PTSD in veterans are:
- Some begin to gradually get symptoms after they get out of war. The symptoms may dissipate with time and possibly come back in the future, or they may linger on until old age.
- Some veterans get hit hard with PTSD symptoms right after their military experience.
- Some may not experience any PTSD symptoms until they are way older.
As people get older, it’s normal to look back in the past, reflect on, and make sense of past experiences. Veterans who don’t really experience symptoms right after war may go through late onset stress symptomatology, or better known as LOSS. While the symptoms of LOSS are pretty similar to PTSD, it may be less severe and depending on the individual the symptoms can be fewer too. Unlike PTSD on a general scale, LOSS is more directly related to aging. People with LOSS generally live pretty comfortable and happy lives — they spend time with loved ones and go to work. As they get older though, they start to deal with changes that come with old age, like more health problems, retirement, and loss of loved ones. These changes, especially if they happen all at once, can have adverse effects. Elderly people with LOSS may begin having more thoughts about their wartime experiences.
It’s not always a bad thing to look back and remember combat days. In fact, some people with LOSS find it productive to reflect because it helps them make meaning of what they went through.
However, if you are having difficulty dealing with your combat memories, there are several methods to seek help or get help yourself. The first and most important step is to not be afraid to ask for help. Know that it is not a sign of weakness, but rather courage and strength. Keeping this in mind, you may want to consider the following to cope:
Keep your mind engaged and your body active. Get outdoors more, exercise, volunteer for a cause that matters to you, and eat well. Loving yourself is very important.
Spend time with positive people.
Open up to a friend or family member who has also gone through military experiences. It always helps to know that you aren’t alone, and that there are plenty out there who have also gone through hard times.
Look into joining a support group. As people get older, feeling lonely or ostracized can exacerbate PTSD symptoms. Being a part of a group will help to mitigate these feelings, and allow you to connect with other people who have gone through similar experiences.
Don’t be afraid to tell your family and close friends about what you are going through. Talking to others not only informs them of your thoughts and experiences, but it can also help you to better understand yourself. If there’s something from wartime that’s triggering some issues you may have like sleep, stress, memory, or anger problems, then your loved ones would be able to provide you with support and assistance too.
If all else fails, speak with a professional. You may find it productive to converse with someone who is trained and experienced in dealing with PTSD and aging. Believe it or not, there are proven and effective treatments for PTSD. Taking action for your own health and well-being early on will allow you to see a therapist sooner and get relevant information on PTSD treatment as necessary for your case.
Getting treated earlier rather than later is crucial if you are dealing with PTSD or LOSS. The reason for this is because the symptoms for both can get worse with age. Addressing the issue now may help curb them from becoming a bigger problem in the future. Early treatment may also help to improve your family life. Those suffering from PTSD may pull away from loved ones for no clear reason or have difficulty getting along with people in general. They may even be violent or aggressive. If you are able to get help with your PTSD symptoms early on, not only will you be able to live a better life sooner, but your family and close friends will also benefit from it. Last but not least, PTSD can also be related to other health issues. For example, studies have shown that heart failure is linked to PTSD. Active treatment for your PTSD could improve your physical health in the long run.
Retirees with Post-Traumatic Disorder
Non-veteran retirees can go through PTSD as well. They may have experienced other forms of trauma such as car accidents, unexpected loss of a loved one, or sexual assault, for example, which lead to PTSD symptoms. Invasive medical procedures and life threatening health diagnoses can also cause PTSD in seniors.
There are various reasons why these symptoms can increase with age:
- When younger, people may resort to avoidance-based coping mechanisms like overworking to keep the mind occupied or drinking alcohol to “escape reality.” While these methods may provide relief early on, they may become less available or not as effective as they age.
- Role changes may make coping with memories of trauma harder for retirees. For example, if you are a parent, you spend most of your prime years working and providing for your children. Once your children are grown and independent, you may start to feel a sense of emptiness. This emptiness may result in your mind wandering to old times.
- There are also physical changes to the body and stressors that come with retirement that may manifest into PTSD symptoms for older adults, such as reduced income, loss of loved ones, cognitive impairment, increased health issues, decreased social support, and declining sensory abilities, to name a few.
Statistics on PTSD in the Elderly
The below statistics gathered from the U.S. Department of Veterans Affairs will provide a better grasp of how PTSD affects the elderly:
Roughly 70-90% of adults who are 65 and older have been exposed to at least one traumatic event in their lifetime.
Several community studies have reported that the prevalence of current PTSD in adults who are over 60 years of age ranges from 1.5-4%.
Not all aging adults meet the full criteria for a PTSD diagnosis, but it’s not uncommon for them to exhibit some symptoms. The percentage of elders with sub-clinical levels of PTSD symptoms ranges from 7-15%.
Approximately 70% of older men reported lifetime exposure to trauma, while older women reported a lower rate of about 41%.
Considering a community sample of older women with an average age of 70 years, 72% went through at least one type of interpersonal trauma during their lives, which can result in PTSD symptoms. Some examples of interpersonal trauma include sexual abuse, rape, or childhood physical abuse.
Homelessness: A Cause of PTSD
Trauma and homelessness go hand in hand. Homelessness is a traumatic experience that can lead to PTSD in a plethora of ways. Homeless adults may feel traumatized after losing stable shelter and being disconnected from family and regular routines and social roles. This is just the beginning. Homeless individuals have to deal with having the constant uncertainty of where to find safe shelter (and shelter that will protect them from brutal weather conditions sometimes) and food to survive. Sleeping on the streets, homeless people witness crazy incidents everyday like murder, physical assault and rape, car accidents, and more. Dealing with this everyday may lead to a sense of hopelessness and symptoms of PTSD like exhibiting reckless behavior, having trouble sleeping, and getting vivid flashbacks of distressing events witnessed.
However, homelessness itself is often a coping mechanism for seniors with PTSD. Once a senior has obtained or been provided stable housing, is when their PTSD generally begins to resurface, as they no longer have the stresses of living on the street to deal with. A stable environment can exacerbate PTSD symptoms in the homeless, therefore making support and educational programs all the more important so that previously homeless seniors can understand the psychological changes they’ll experience in a stable environment. Services can be referred to the senior in how to cope with their PTSD in their new living arrangements, so that they don’t willingly go back out onto the streets as a coping mechanism.
Treating Post-Traumatic Disorder
Research into treatments for PTSD has grown in recent years, bringing to light several ways to help seniors manage their PTSD issues. From medications that focus on restoring balance to brain chemical imbalances, to reducing social isolation and early intervention programs.
Support Groups to Reduce Isolation
A senior with PTSD is more likely to withdrawal from others as they may feel embarrassed from their traumatic experience(s). This exasperates traumatic episodes in the senior’s mind, through intrusive memories and dreams. Medical conditions can be further traumatize seniors with PTSD from combat experience or childhood trauma, such as procedures for urologic cancers that cause embarrassment and pain. Support groups going through the same procedures that allows for seniors to share their experiences and form camaraderie with others, has helped to lessen PTSD episodes amongst seniors. The burden of isolation is reduced, and the senior may be able to work on their relationships outside of the support group as well.
Another useful factor of support groups and communication with others going through the same medical procedures and senior living issues, is how it helps seniors with PTSD to manage and develop plans for upcoming medical appointments. MRI scans often trigger traumatic combat experiences, when seniors communicate with each other in preparation for upcoming appointments, they are more able to get through the procedure with ease, as they are prepared for it and have companionship.
Psychotherapy can be effective in targeting specific symptoms of PTSD like hyperarousal and re-experiencing traumatic events from decades ago. Having the senior tell and retell their traumatic experience repeatedly to a medical professional, can help the senior to understand and come to terms with what they went through. This can be very therapeutic as the senior may have suppressed and kept the traumatic experience to themselves for decades. Telling the traumatic out loud helps the senior to reconstruct their experience into a cohesive narrative, rather than fragmented memories that can be triggered at any time. With a cohesive narrative, the senior can developing meaning from the experience, and come to terms with it. The retelling of the experience out loud also helps the senior to not immediately feel fear, as it desensitizes their stimuli that would elicit a fearful response. Lastly, and as we’ll go into further detail in the next section, retelling of the story to someone else helps the senior to not feel so emotionally and mentally isolated, by having someone else bear witness to their story.
Consideration of the Senior’s Lifespan
Research has shown that seniors between 55-65 years of age are more like than older seniors between 75-85 to experience PTSD brought on by diagnosis and treatment of cancers. The older seniors are less likely to develop PTSD from medical issues like cancer due to their longer lifespan, having experienced more emotional challenges and developing ways to deal with them compared to younger seniors. Knowing this helps producing an effective and customized PTSD treatment plan, as approaching seniors in their 60s is not the same as treating PTSD in seniors in their 70s and 80s.
Seniors with PTSD have a high rate of not taking medications consistently, due to worrying about side effects and possible addiction, the cost of the medication, and just not placing any value on medications. Patients are often prescribed benzodiazepines (BZDs), which helps with lowering anxiety. In younger patients they can sometimes be helpful, but there are risks associated with BZDs among seniors. The higher chance of impairments like dementia, cardiac diseases, and slower and damaged metabolic processes increase the possibility of adverse side effects such as confusion, falls, gait impairment, and unsafe behaviors like like improperly driving a vehicle.
The FDA has approved 2 medications that are known as selective serotonin reuptake inhibitor (SSRIs), which are essentially antidepressants. The purpose of these medications is to restore balance to the natural inhibitory response of the brain, which prevents overstimulation and high anxiety when it is out of tune. Antidepressants can prove to be very effective amongst seniors, but close monitoring is required and an open and continuous dialog between the doctor and the senior is a must as to manage expectations and to be sure no adverse side effects are occurring.
Lastly, seniors can receive medications for psychosis which can result from dementia bringing out PTSD from decades ago. Again, the use of psychiatric medications is to be closely monitored, with benefits weighed against the risks of side effects. Side effects with anti-psychosis medications include metabolic syndrome, cardiovascular risk, and weight gain. It is also important to ‘start low and go slow‘ as with any medications used with seniors, but to not be overly cautious as to prevent reaching an effective dosage amount.
There are extensive scholarly research papers on the use of medication to treat PTSD in seniors. Here are a few links for further reading:
- The Psychopharmacology Algorithm Project – This updated research paper goes over the effects of antidepressants in the treatment of PTSD in seniors as a last resort.
- Health Outcomes of Medication Adherence Among Seniors – This paper goes into detail on attempts to improve senior adherence to medications and their effects.
- Clinical Geriatric Psychopharmacology – This book goes into great detail on the use of psychiatric medications on seniors with PTSD.
PTSD is a serious issue that should not be overlooked. Anyone who has encountered a traumatic or disturbing event in life can develop symptoms. If not treated in a timely manner, the symptoms could get worse and debilitating. With that said, getting help as early as possible is important so that your PTSD won’t snowball into something more complicated later on.