Posttraumatic Stress Disorder in Older Adults

Posttraumatic stress disorder (PTSD) is a common and disabling psychological consequence in the aftermath of traumatic events in older adults. Nevertheless, symptoms of PTSD are often misdiagnosed in older adults because of concurrent mental and physical problems. The scarcity of evidence-based empirical research on PTSD and its characteristics in older adults lies behind these misdiagnoses. Research so far has led to the understanding that particular challenges in the therapeutic process must be taken into account when providing psychotherapy to older PTSD patients and therefore, age- specific adaption is needed. To address the above-mentioned gaps in research, four research studies investigated the characteristics and treatment of PTSD in older adults with early-lifetime traumatization. The overview set out a summary of the characteristics of PTSD and its current treatment approaches in older adults. Research into characteristics indicated that the timing of the trauma (recent vs. early life) impacts prevalence rates, course and symptom profile of PTSD in older adults. Current data demonstrates generally lower prevalence rates and symptom severity in older than in younger adults with acute traumatization. Regarding early-life traumatization, a decline in PTSD symptom severity could be observed over the life span. However, a change in shape of PTSD symptoms was observed in a subgroup of older adults, indicating an increase in avoidance symptoms and a decrease in re-experiencing symptoms. Research into PTSD treatment approaches for older adults indicated that PTSD- specific interventions could be effectively combined with age-specific approaches. The overview allowed a general classification of the characteristics of PTSD symptoms in older adults. Article II broadens the knowledge about predominant typologies of PTSD in treatment-seeking older adults. The hypothesis was that the typologies in older adults are similar to those in other age cohorts (intermediate and pervasive) and that the pervasive disturbance group would be best characterized by a higher level of avoidance symptoms. The findings suggested that PTSD in treatment-seeking older adults may be characterized by three predominant typologies: an intermediate disturbance class and two pervasive disturbance classes which differed by their level of avoidance symptoms (high and low avoidance). Both pervasive disturbance classes showed higher depression, anxiety and somatization symptoms and a higher number of traumatic events compared to the intermediate disturbance class. Articles III and IV focused on the treatment of PTSD in older adults. Article III evaluated the efficacy of an age-specific Internet- based writing intervention (Integrative Testimonial Therapy) in mitigating PTSD symptoms. ITT combined well-evaluated PTSD-specific CBT components and age-specific components. The pilot study revealed a significant decrease in PTSD symptom severity as well as significant increase in constructive dimensions (quality of life, self-efficacy and posttraumatic growth) from pre- to post-treatment. These results remained stable at three-month follow-up. To extend the findings of Article III regarding specific variables that may mediate the response to this effective treatment approach, Article IV aimed at examining the influence of predictor variables on treatment outcomes for PTSD in older adults. Because of the inconsistent findings on previously evaluated predictors of PTSD treatment response, Article IV also focused on additional predictor variables by including constructive variables, which changed during the ITT. Results revealed that higher scores of initial internal locus of control and posttraumatic growth predicted a better outcome at posttreatment, even after controlling for initial PTSD severity. To sum up, the findings of the current thesis enhance the knowledge of PTSD in older adults with early- life traumatization. They provide insights into the heterogeneous manifestation of PTSD symptom clusters in older adults, underscoring the importance of considering this in assessment and treatment approaches in this age cohort. The findings also provide promising insights into evidence-based age-specific treatment for PTSD regarding potential outcome predictors and potential effective treatment components. In view of demographic change and taking into account the fact that PTSD is a disabling disorder, it is a matter of urgency that clinical routine should effectively reach and address the needs of older adults suffering from PTSD.

Author dc:creator

• Böttche, Maria

• older adults
• PTSD
• treatment
• typologies
• predictor

Licence dc:rights.uri

• http://www.fu-berlin.de/sites/refubium/rechtliches/Nutzungsbedingungen

Language dc:language

eng

Identifier URI

http://dx.doi.org/10.17169/refubium-14651

OAI record oai:identifier

https://refubium.fu-berlin.de/oai/request?verb=GetRecord&metadataPrefix=dim&identifier=oai%3Arefubium.fu-berlin.de%3Afub188%2F10453