ithin the last cen-tury, the average liespan has increasedby 37%, with many people liv-ing well into their 80s and 90s. Itis estimated that by 2030, morethan 15 million older adults willexperience a mental illness. Theaging o the Baby Boomer cohortand greater longevity is responsi-ble or this statistic (U.S. Depart-ment o Health and Human Ser-vices [USDHHS], Ofce o theSurgeon General, 1999). The es-timated prevalence rate or anxi-ety disorders in adults age 55 andolder is approximately 11%. Thispercentage is greater than that o any other disorder associated witholder adults (USDHHS, Ofce o the Surgeon General, 1999). Inparticular, posttraumatic stressdisorder (PTSD) in older adultsis an underrecognized and under-treated disorder that can result inpsychosocial disability, substanceuse, and other negative healthoutcomes. For this reason, thepurpose o this article is to exam-ine this disorder as it relates toolder adults and increase healthcare provider sensitivity to theinterrelationship o mental andphysical health when addressingthe needs o older adults withthis disorder.
DifferentiAl DiAgnosisof PtsD
As Americans live longer,the psychological stressors someindividuals sustained at earlierlie stages can become deterrentsto successul aging (USDHHS,Ofce o the Surgeon General,1999). This is especially trueor individuals who are exposedto trauma related to combat,ravages o war, sexual abuse, orevents a person conceptualizes ascatastrophic, and when availablecoping mechanisms ail (Murray,2005). In the case o older adults,research surrounding trauma andresponses to trauma has been pri-marily inclusive o male veteranpopulations. However, severalstudies do address trauma-relatedissues or civilian older adult e-male populations. An area o re-cent interest is the reoccurrenceo trauma-related stress symp-toms in later lie.
Au s Dd
The majority o individualsexposed to an acute stress epi-sode will recover in the monthsollowing the traumatic eventand will not require ormal inter-vention. These individuals allwithin the diagnostic categoriesoutlined in the
Diagnostic andStatistical Manual of Mental Dis-orders
, ourth edition, text revi-sion (American Psychiatric As-sociation, 2000) or acute stressdisorder (ASD) (Bryant, 2003).Symptoms related to ASD occurwithin a month o a traumaticevent. Symptoms are categorizedinto six areas:
Cluster A—earul re-sponse ater a traumatic event.
Cluster B—three dissocia-tive symptoms.
Cluster C—re-experienc-ing symptoms.
Cluster D—marked avoid-ance.
Cluster E—marked anxiety.
Cluster F—evidence o sig-nifcant distress or impairment ineveryday task completion.
Disturbance in all six areasidentifed or ASD must last aminimum o 2 days and a maxi-mum o 4 weeks beore the diag-nosis o PTSD can be assigned.Three Cluster B symptoms o dis-sociation need to be present or adiagnosis o ASD:
Subjective sense o numb-ing or detachment.
Reduced awareness o sur-roundings.
Derealization, depersonal-ization, or dissociative amnesia.These symptoms block processingo traumatic memories and adap-tation. Interestingly, individualswho develop PTSD do not alwaysreport Cluster B symptoms (Bry-ant, 2003). It is proposed thatboth individuals who experienceall symptoms and those who ex-perience all but Cluster B symp-toms can be at risk or developingPTSD (Bryant, 2003). Symptomscan abate and resurace overmonths or years and can reoccurin ull orce i the person is retrau-matized. While survivor symp-toms can persist as an individualages into older adulthood, howthese symptoms are expressed isvery individual and may dependon genetic and epigenetic ac-tors, premorbid personality traits,early lie experiences, and socialsupport (Weintraub & Ruskin,1999). Consistent fndings reportthat delayed onset o PTSD is rarewhen no prior exposure to traumahas occurred (Andrews, Brewin,Philpott, & Stewart, 2007).
PreDictive fActorsfor PtsD
Age can oer a protectiveshield against the eects o a trau-matic event through the passageo time and successul lie expe-riences. Factors that seem to beassociated with resilience againstthe development o PTSD in-clude marriage, social support,increased socioeconomic sta-tus, and religion (Weintraub &Ruskin, 1999). Across studies, noagreement has been reached onthe symptom combination that ispredictive o PTSD, and or thisreason, increased attention has