PTSD Among Aging Adults

Post-traumatic stress disorder, also known as PTSD, can happen to people of all ages. It affects aging adults because they are more likely 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 condition 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. PTSD happens because the body hasn't fully recognized that the life-threatening event is over. 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.

Causes

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, including:

• 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, and 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?

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 may also play some part in it. For example, if you were raised by a parent with mental health challenges, you may be more likely to develop PTSD in your lifetime.

Symptoms

Various symptoms may manifest in those who have 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 and Aging Veterans

Military experience is not something easily forgotten. It is life-changing. In fact, many aging veterans still have vivid memories of 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 in the media may bring back bad memories
• Getting diagnosed with medical issues, resulting in feeling weak and helpless
• Coping with stress in an unhealthy way, like using substances or alcohol more often, which can 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. 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 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 could even be violent or aggressive. If you can 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. 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 experience PTSD as well. They may have experienced other forms of trauma such as car accidents, unexpected loss of a loved one, or sexual assault, 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 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 every day like murder, physical assault and rape, car accidents, and more. Dealing with this every day 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 PTSD symptoms. 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 withdraw 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 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 allow seniors to share their experiences and form camaraderie with others. This helps lessen PTSD episodes among 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.

Connecting with others going through the same challenges helps seniors with PTSD manage and develop plans for upcoming medical appointments. MRI scans often trigger traumatic combat experiences. When seniors support each other in preparation for upcoming appointments, they can get through the procedure with greater ease.

Psychotherapy

Psychotherapy can be effective in targeting specific symptoms of PTSD like hyperarousal and re-experiencing traumatic events from decades ago. Here are two forms of therapy older adults can consider:

Talk Therapy

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 event 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 develop 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 the stimuli that would elicit a fearful response. Lastly, retelling the story to someone else helps the senior feel less emotionally and mentally isolated, by having someone else bear witness to their story.

Somatic Therapy

Somatic therapy is a type of body-centered therapy that also includes talk therapy. It focuses on the connection between the mind and body to help individuals heal from trauma. This form of therapy operates on the information that trauma is stored in the body and mind. For PTSD, somatic therapy uses touch-based techniques to help both the mind and body process and release trauma.

These techniques have also been reported to relieve many of the symptoms caused by PTSD, including feeling on guard all the time and overwhelming physical tension. Many people will opt for somatic therapy if they feel that their treatment in talk therapy has plateaued. As this form of therapy involves touch, it's best to ask yourself if you feel comfortable receiving it.

Whether you're looking for talk therapy or somatic therapy, make sure to speak with potential therapists. It's important to make sure it's a good fit before beginning therapy. Finding the right therapist can help you continue therapy more consistently and get better results.

If you're not sure about therapy because of the costs, there are affordable options. Open Path Psychotherapy Collective provides therapy sessions between $40 to $70 for those who are not able to pay typical out-of-pocket costs.

Pro Tip: Looking for a therapist? While it might feel intimidating at first, know that therapy is for everyone – not just people with PTSD. Start with friends and family members you trust and ask them for referrals. You can also go to Psychology Today and search for therapists in your area. Most therapists list their information on the site, so you'll find a plethora of potential therapists.

Consideration of the Senior’s Lifespan

Research has shown that seniors between 55 to 65 years of age are more likely than older seniors between 75 to 85 to experience PTSD brought on by the diagnosis and treatment of cancers. 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 produce 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.

Medications

Seniors with PTSD have a high rate of not taking medications consistently. This is 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 lower 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 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.

Further Reading

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.

Final Thoughts

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.