Aggression and Violent Behavior xxx (xxxx) xxxx

Contents lists available at ScienceDirect

Aggression and Violent Behavior

journal homepage: www.elsevier.com/locate/aggviobeh

Resilience and post-traumatic growth following late life polyvictimization: A

scoping review☆
⁎
Alexandria G. Nuccio , Ashley M. Stripling
Department of Psychology, Nova Southeastern University, USA

A R T I C LE I N FO A B S T R A C T

Keywords: Late life polyvictimization occurs when an older adult experiences multiple types of abuse, including elder
Resilience abuse, either simultaneously or sequentially, and impacts roughly 1 in 4 elder abuse cases. Although the effects
Post-traumatic growth of late life polyvictimization can include mental and physical health disorders, some older adults demonstrate
Post-traumatic stress disorder post-traumatic growth following trauma both earlier and later in life. However, to date, our understanding of
Polyvictimization
resilience and post-traumatic growth following lifelong trauma and late life polyvictimization has not been
Older adult
Late life
systematically explored. As such, the current scoping review examines resilience, post traumatic growth, and
Elder mental health in late life. Although sparse, identified articles did provide significant links between resilience,
post-traumatic growth, and PTSD in late life in line with the resilience portfolio framework. Recommendations
and guidelines to guide future research are discussed.

1. Introduction
1.1. Elder abuse and polyvictimization
As the United States population ages, modernizes, and diversifies,
those achieving late life face unique challenges including elder abuse;
defined for the purposes of this paper as an intentional act or omission
that involves the harm or potential harm, failure to provide an essential
service, or the deprivation of basic needs to an older adult by an in-
dividual who is viewed as being in a trusted relationship with the elder
(Amstadter et al., 2011; Biggs & Haapala, 2010; Burnes et al., 2016;
Bužgová & Ivanová, 2011; Enguidanos et al., 2014; Johannesen &
LoGiudice, 2013; Litwin & Zoabi, 2003; Penhale, 2010; Pickering et al.,
2017; Plitnick, 2008; Vandsburger et al., 2010; Yan et al., 2015). Cur-
rent prevalence rates, which vary by type of abuse (i.e. physical, sexual,
emotional, financial, and neglect1), are estimated to fall between 2%
and 11.4% (Brent, 2015; Burnes et al., 2016; Conner et al., 2011;
Johannesen & LoGiudice, 2013; Pickering et al., 2017; Plitnick, 2008;
Yan et al., 2015); and are understood to likely be underestimates with
true prevalence rates roughly five times higher (Biggs & Haapala, 2010;
Plitnick, 2008; Vandsburger et al., 2010). This is concerning as those
who suffer abuse in late life are more at risk for physical and psycho-
logical injuries, with older adults who have experienced some form of
elder abuse being more likely to report severe bodily injuries, lower
self-rated physical health, and increased rates of depression than their
un-abused counterparts (Amstadter et al., 2011; Burnes et al., 2016;
Yan et al., 2015). These injuries in turn can lead to an increased number
of hospitalizations, possible placement in nursing homes, increased
mortality risk, and in extreme cases, pre-mature death (Burnes et al.,
2016; Yan et al., 2015).
Unfortunately, even as our understanding of elder abuse grows,
there are still large gaps in the literature, specifically regarding the role
of polyvictimization in late life and its impact on older adults. Late life
polyvictimization occurs when an older adult experiences multiple
types of elder abuse that are either co-occurring or sequential in nature
(i.e., an older adult experiencing neglect after being moved away from a
sexual assault perpetrator), and can be done by one or more perpe-
trators who are in a trust relationship with the elder (Ramsey-Klawsnik,
2017; Teaster, 2017). Although it wasn't until recently that the term
polyvictimization was used within the elder abuse literature, research
dating back 25 years has demonstrated frequent instances of co-oc-
curring elder abuse (Heisler, 2017; Ramsey-Klawsnik, 2017). In a recent
study polling Adult Protective Service professionals across the nation,
15% reported that 80% of their caseload was comprised of victims of
multiple types of abuse, while an additional 75% of respondents re-
ported that polyvictims comprised 25% of their caseloads (Ramsey-

☆
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
⁎
Corresponding author at: Nova Southeastern University, 3301 College Ave, Fort Lauderdale, FL 33314, USA.
E-mail address: an862@mynsu.nova.edu (A.G. Nuccio).
1
Interested readers are directed to the following articles for more information: Galpin (2012) and Johannesen and LoGiudice (2013)

https://doi.org/10.1016/j.avb.2020.101481
Received 14 April 2020; Received in revised form 6 July 2020; Accepted 13 July 2020
1359-1789/ © 2020 Elsevier Ltd. All rights reserved.

Please cite this article as: , Aggression and Violent Behavior, https://doi.org/10.1016/j.avb.2020.101481
A.G. Nuccio and A.M. Stripling
Klwasnik & Heisler, 2014). The effects of polyvictimization on older
adults can be seen long after the abuse ends, with some polyvictims
experiencing a severe lack of self-esteem, feelings of powerlessness, and
various mental health disorders, namely post-traumatic stress disorder
(Ramsey-Klawsnik, 2017).
1.2. Post-traumatic stress disorder
Despite polyvictimization being linked to late life post-traumatic
stress disorder (PTSD), rates of PTSD in the older adult population are
significantly lower (2.6%–4.5%) than that of young to middle aged
adults (8% - 10%) (Cook et al., 2017; Dinnen et al., 2015; Reynolds
et al., 2016). However, as we age, the likelihood that we will experience
at least one traumatic event significantly increases, with current rates of
lifetime exposure to possibly traumatic events estimated to be between
74.2% and 96.1% in older adults (Dinnen et al., 2015). With this in-
creased exposure to traumatic events and the presence of late life PTSD,
both at a clinical and subclinical level, comes a wide variety of com-
plications. Older adults suffering from PTSD report less successful
aging, decreased cognitive functioning, comorbid psychiatric disorders,
and are at increased risk for a number of physical health problems (i.e.
cardiovascular disease, gastrointestinal ulcers, type 2 diabetes, pre-
mature biological aging, and increased mortality) (Cook et al., 2017;
Knaevelsrud et al., 2017; Palmer & Raskind, 2016; Shrira et al., 2016).
1.3. Resilience and post-traumatic growth
The Latin word ‘resiliens’ refers to a substances pliant or elastic
quality, and is the basis of the word resilience, which has been con-
ceptualized as a dynamic process in which individuals experience some
form of adversity or trauma, and adapt in a way that allows them to
function better than expected (Bolton et al., 2016; Cosco et al., 2017;
Chokkanathan & Aravindhan, 2018; Hildon et al., 2009; Tomás et al.,
2012; Zhang et al., 2017). Initially introduced into the field of psy-
chology by Werner (1982) and Smith (Werner & Smith, 1992), resi-
lience was explored in high-risk children in an attempt to understand
the mechanisms by which some children overcome early adverse life
events (Bolton et al., 2016; Cosco et al., 2017; Kessel, 2013). To date,
research has linked resilience from early childhood through midlife
with increased problem-solving abilities, the ability to identify external
resources when needed (i.e., friends, family), and increased recognition
of individual strengths and capabilities (Lamet & Dyer, 2004; Wagnild
& Collins, 2009).
The Resilience Portfolio Model, created by Grych et al. (2015) is a
summative model that utilizes psychological constructs such as positive
psychology, posttraumatic growth, and coping, to better understand
how individuals who have experienced adversity can go on to build
meaningful lives. This model identifies higher-order strengths that are
particularly salient for resilience (i.e., regulatory, interpersonal, and
meaning-making strengths), utilizes a multi-dimensional approach
when defining resilience, and adopts a lifespan focus from infancy to
adulthood. More importantly, the Resilience Portfolio Model integrates
individual character strengths with protective factors identified in
preexisting resilience research to provide a comprehensive account of
the various qualities that can lead to increased functioning in response
to adverse or traumatic experiences (Grych et al., 2015; Hamby et al.,
2016).
Despite the identified advantages of resilience through adulthood,
research on resilience in later life is a lesser understood phenomenon
(Kessel, 2013). Since its induction into the older adult literature, re-
searchers have found resilience to be an adaptive function in older
adults, allowing for increased physical and mental health as well as
decreased recovery time after experiencing physical and mental
traumas (Hassani et al., 2017; Ohana et al., 2014). In older adults over
85, the capacity for resilience has been found to mirror that of their
younger counterparts, which suggests resilience may lead to decreased
2
Aggression and Violent Behavior xxx (xxxx) xxxx
mortality and increased longevity (MacLeod et al., 2016). Further, re-
silience has been linked to decreased rates of mental illnesses such as
depression and anxiety, and multiple positive characteristics in late life,
such as forgiveness, self-perceived quality of life, successful aging, and
purpose in life (Fullen et al., 2018; MacLeod et al., 2016; Rana et al.,
2014; Wagnild & Collins, 2009).
While resilience refers to an individual's ability to bounce back after
facing adversity, post-traumatic growth is an individual's ability to
achieve higher levels of functioning and positive growth following
traumatic experiences (Garrido-Hernansaiz et al., 2017; Kessel, 2013;
Tsai et al., 2016). Post-traumatic growth has been reported by in-
dividuals who've experienced a wide range of traumatic events, and is
frequently associated with deeper relationships with others, a greater
appreciation for life, and an increased perception of oneself as a strong
and capable individual (Rzeszutek et al., 2017; Tsai et al., 2016).
However, inherent in the definition of both resilience and post-trau-
matic growth, is the experience of a challenge, adverse experience, or
trauma, including those unique to late life such as elder abuse (Eshel
et al., 2016; Lamet & Dyer, 2004; Tsai et al., 2016; Zhang et al., 2019).
1.4. Purpose of the scoping literature review
Although researchers are aware that resilience and post-traumatic
growth act as protective factors against PTSD in other age groups, the
research literature regarding the relationship between resilience and
post-traumatic growth, and these concepts' impact on late life PTSD
remains unknown despite calls to integrate resilience models into late
life poly-victimization research (Hamby et al., 2016). And further, the
possible relationships between resilience and post-traumatic growth as
protective factors against the negative outcomes of late life poly-
victimization, and that of polyvictimization and late life PTSD, have not
been systematically mapped. As such, the purpose of the current study
is to review the available literature regarding the relationship between
resilience and post-traumatic growth, and the role that resiliency and
post-traumatic growth may have on late life polyvictimization and
PTSD. This scoping review aims to provide a clear and concise syn-
thetization of the available research to date, in addition to drawing
connections between the aforementioned topics in an attempt to iden-
tify what researchers already know and where the gaps in the literature
currently reside.
2. Method
2.1. Study selection criteria
For a study to be included in this review, it needed to meet the
following criteria: (1) the sample included older adults, over the age of
65, (2) the relationship between resilience, post-traumatic growth,
PTSD, and/or polyvictimization was examined, and (3) they were
written in the English language. PRISMA-ScR guidelines, established by
Tricco et al. (2018), were utilized during the search and review phases
of this scoping review. As a result of the limited research available in
the above-mentioned areas, peer-reviewed articles including multiple
age points were included if they included a clear delineation between
age groups and findings specifically related to the older adult popula-
tion.
2.2. Study selection criteria
Source documents for this literature review were identified through
a computerized search using AgeLine, CINAHL, PsycInfo, PsychData,
Google Scholar, and Proquest bibliographical databases. Search terms
were grouped into four main areas – post-traumatic stress disorder in
late life, polyvictimization in late life, resilience in late life, and post-
traumatic growth in late life – and were systematically mapped. In an
effort to avoid omissions, reference sections of previous reviews were
A.G. Nuccio and A.M. Stripling Aggression and Violent Behavior xxx (xxxx) xxxx

Records identified through data Additional records identified through contact

base searching with experts, screening reference lists and
( n = 91 ) searching key journals
( n = 11 )

Records after duplicates removed

( n = 102 )

Records excluded
Record titles and abstracts read ( n = 80 )
( n = 102 )

Records excluded
Full text articles assessed for eligibility (n=5)
( n = 22 )

Studies with samples of Studies with 65 and older

subjects 65 and older included in the sample
(n = 8 ) (n = 9 )

Fig. 1. A flow diagram of the research selection process.

examined, and additional texts were located. Consistent with a thor-
ough analysis, all English language abstracts were read, as were the full
articles of those texts that appeared relevant to this literature review.
Fig. 1 presents the PRISMA-ScR driven selection process.
The search conducted in April of 2020 identified 102 publications.
All titles and abstracts were screened, and after the elimination of ar-
ticles that did not meet the relevant inclusion criteria, seventeen arti-
cles were included in the review: Eight of which focused on late life and
an additional nine of which included both adults and elders.
3. Results
3.1. Descriptive characteristics of the studies
Overall publication dates ranged from 2003 to 2020, with articles
studying PTSD and post-traumatic growth among Holocaust survivors
(Kimron et al., 2019; Lev-Wiesel & Amir, 2011; Lurie-Beck et al., 2008;
Shrira et al., 2011), natural disasters (Seo & Lee, 2020; Shrira et al.,
2014), war veterans (Tran et al., 2013), adverse health events (Gall,
Charbonneau, & Florack, 2008; Lechner et al., 2003; Moore et al., 2012;
Sheikh & Marotta, 2017; Thornton & Perez, 2006) and various life
stressors (Cabral, 2010; Palgi, 2016; Park et al., 2005; York, 2008). The
identified study samples ranged from 23 to 1000; with a majority of the
elder participants experiencing genocide, War, or various stressors;
reporting a mean age range of 43.64 to 82.52; and being mostly ba-
lanced between men and women. The study samples were recruited
from national, community, and medical settings, and were generally
somewhat representative of the overall population. Characteristics of
each study are described in Table 1.
3.2. Resilience, post-traumatic growth, and trauma
Although sparse, identified articles did provide significant links
between resilience or post-traumatic growth (PTG) and PTSD in late
life, with PTG from early life events found to positively influence
coping, death attitudes, and recent stressor adjustment (Moore et al.,
2012; Park et al., 2005). Studies differed in the number of traumatic
events needed to promote resilience in late life, with one saying fewer
(Tran et al., 2013), one greater (Kimron et al., 2019), and one in-
dicating no relationship (York, 2008). With regards to the relationship
between age and PTG, findings were mixed as well, with some studies
noting an increase with age (Lurie-Beck et al., 2008; Seo & Lee, 2020;
Shrira et al., 2014) and some studies noting, although present, PTG
occurred to a lesser extent in late life than in younger samples (Lev-
Wiesel & Amir, 2011; Lechner et al., 2003; Sheikh & Marotta, 2017).
In line with previous research utilizing the Resilience Portfolio
Model framework (Grych et al., 2015; Hamby et al., 2016), support was
found for regulatory strengths (i.e., emotional regulation, emotional
awareness, and endurance) (Cabral, 2010; Moore et al., 2012; Palgi,
2016; Park et al., 2005; Thornton & Perez, 2006), interpersonal
strengths (i.e. compassion, community, and generativity) (Sheikh &
Marotta, 2017; Moore et al., 2012; Lev-Wiesel & Amir, 2011) and
meaning making strengths (i.e. purpose, optimism, religious meaning
making) (Shrira et al., 2011; York, 2008; Palgi, 2016; Thornton & Perez,

3
 Table 1
Study characteristics.
Study N Mean age Age range % of men Protective factor Traumatic event Key findings

Kimron et al. (2019) 246 82.52 68–100 63.10% PTG Holocaust Holocaust survivors demonstrated higher levels of PTG than their non-survivor counterparts.
Results also demonstrated that a certain amount of post-traumatic symptoms are needed for PTG to
occur
Lurie-Beck et al. (2008) 23 75.13 62–94 56% PTG Holocaust A positive relationship was found between PTG and PTSD symptoms but not between PTG and
A.G. Nuccio and A.M. Stripling

depression. PTG was also positively related to survivor age, arousal, and being separated from
family during the Holocaust.
Shrira et al. (2011) 721 81.28 75–95 57.05% R Holocaust Individuals who self-identified as a “Holocaust Survivor” demonstrated higher general resilience
than individuals who experienced similar circumstances, but did not self-identify as a “Holocaust
Survivor,” suggesting a relationship between positive self-labeling (i.e., survivor vs non-survivor)
and general levels of resilience.
Tran et al. (2013) 293 82.1 66–99 38.60% R World War II Results from this study provided no clear answer regarding resilience's role in decreased levels of
PTSD in WWII survivors. However, an association between fewer number of traumatic events and a
medium level of education were associated with promoting higher levels of resilience in late life.
Park et al. (2005) 83 77.9 58–100 26.5% PTG Various (death of a love one, illness, Results indicate post-traumatic growth from early traumatic events can positively influence
war, work, family) subsequent coping, death attitudes, and recent stressor adjustment.
York (2008) 49 75.67 65 - > 85 16.3% Rel. Life stressors Religiosity predicts successful aging, but not above demographic factors and total accumulated life
stressors were not related to successful aging.
Palgi (2016) 399 65.44 50–90 44% PTG Exposure to rocket fire Results indicate a strong linear and curvilinear relationship between PTSD and PTG suggesting
process and acknowledgement of the trauma is needed to make positive change. Authors also note
subjective age was not directly related to PTG, perhaps supporting the subjective weathering
hypothesis.
Lev-Wiesel and Amir 97 67.9 NR 48% PTG Holocaust Social support from friends positively contributed to PTG and the higher the level of personal
(2011) resources the lower the PTSD symptomatology. Of note, PTG was related to the PTSD symptom of
arousal and the authors found that sample's PTG to be lower than other age groups.
Seo and Lee (2020) 200 NR 20–65 50.50% PTG Earthquake No significant differences were found in individual levels of PTSD reported by young (20–29) and

4
middle (30–49) aged adults compared to older adults (50–65); however, levels of PTG did
significantly differ by age, with older adults reporting significantly higher rates of PTG than their
younger counterparts.
Shrira et al. (2014) 1000 45.16 18–82 34.50% R 9/11 & Hurricane Sandy Conclusive causational results were not obtained in this study, however it was found that on
average older adults possess higher levels of resilience when compared to the young adults who
participated in this study, indicating that older adults may have overall increased levels of
resilience than younger aged adults.
Lechner et al. (2003) 83 62.5 34–85 29% PTG Cancer Younger cancer patients and those being treated for Stage-II cancers reported higher levels of PTG
when compared to other cancer stages.
Thornton and Perez 82 survivors 61.27 41–78 NR PTG Prostate cancer Higher levels of pre-surgery negative affect and coping (i.e. positive reframing and emotional
(2006) 67 partners 57.36 37–77 support) resulted in higher PTG one-year post surgery in survivors. Positive reframing, higher pre-
surgery cancer specific avoidance, lower education, and marriage to employed patients resulted in
higher PTG one-year post surgery in partners.
Gall et al. (2008) 87 60.95 NR 0% PTG Breast cancer Findings suggest a mixed relationship between religious/spiritual factors and PTG. While cancer
SD = 11.25 stage and a positive image of God was not related to PTG, religious meaning making and using
religion as a distraction was related to PTG post-surgery
Moore et al. (2012) 202 63 30–94 73% PTG Advanced cancer When diagnosed, both patient and family caregivers reported high stable PTG; with optimism, and
recent traumatic life events (i.e. recent losses, physical injury) significantly associated with
patients PTG and caregivers report PTG as a result of the diagnosis. Depression and quality of life
were not found to be associated to PTG.
Sheikh and Marotta 124 64 36–87 78% PTG Myocardial infarction or CABs Cardiac patients reported PTG in perceptions of self, other and philosophy of life, as well as, PTG
(2017) related to spirituality or connected, however lower than was found among college students.
Cabral (2010) 143 29.88 18–65 17.9 PTG Interpersonal violence Among participants, including the 4.2% who reported elder abuse, severity of depressive
symptomatology was negatively related to PTG and hope and increased severity of PTSD positively
predicted PTSD.
Thomas (2018) 158 43.64 18–72 26.5 PTG Life stressors Although there was no difference in PTG between those of interpersonal and non-interpersonal
trauma, those experiencing interpersonal trauma reported significantly higher PTSD symptom
severity.

Note. NR = not reported; protective factor: PTG = post-traumatic growth, R = resilience, Rel. = religiosity.
Aggression and Violent Behavior xxx (xxxx) xxxx
A.G. Nuccio and A.M. Stripling
2006; Gall et al., 2008; Moore et al., 2012; Sheikh & Marotta, 2017;
Park et al., 2005). Additionally, a thorough review of the literature
revealed the importance of positive reframing and self-labeling to
promote resilience in late life (Kimron et al., 2019; Shrira et al., 2011;
Thornton & Perez, 2006).
With regards to the relationship between PTSD symptomatology,
particularly that of arousal, and post traumatic growth in late life,
support was found for both a curvilinear and linear relationship (Lev-
Wiesel & Amir, 2011; Lurie-Beck et al., 2008; Palgi, 2016; Cabral,
2010), however the directionality of these relationships was mixed. A
number of studies also examined depressive symptomatology following
adverse events with relation to PTG and found that depressive symp-
toms were either not related (Lurie-Beck et al., 2008; Moore et al.,
2012) or negatively related to PTG (Cabral, 2010). Taken together, a
number of authors suggested that emotional awareness in the form of
processing and acknowledgement of the trauma, particularly of the
symptoms of arousal, is instrumental in order to make positive change
(Palgi, 2016; Lev-Wiesel & Amir, 2011; Thornton & Perez, 2006; Cabral,
2010; Thomas, 2018).
Finally, despite multiple attempts to locate studies in which the
relationship between resiliency or post-traumatic growth and late life
elder abuse related polyvictimization was explored, only one article
was identified which included elder abuse among 4% of the study
(Cabral, 2010). Unfortunately, this sample was not stratified by age or
abuse type and thus implications are limited.
4. Discussion
In this scoping review, 17 articles were identified that addressed
either resiliency or post-traumatic growth in late life related to various
forms of Post-Traumatic Stress Disorder between the years of 2003 and
2020. Present findings indicate a general lack of consistency regarding
both post-traumatic growth and resiliency in older adults who have
experienced traumas. Although post-traumatic growth experienced as a
result of early life traumas was associated with increased coping,
stressor adjustment, and death attitudes (Moore et al., 2012; Park et al.,
2005), the relationship between age and post-traumatic growth remains
mixed (Lev-Wiesel & Amir, 2011; Lechner et al., 2003; Lurie-Beck et al.,
2008; Sheikh & Marotta, 2017; Shrira et al., 2014; Seo & Lee, 2020).
Regarding resilience in late life, current research is unclear of the
number of traumas an individual needs to experience to promote resi-
lience in late life (Kimron et al., 2019; Tran et al., 2013; York, 2008),
but the resiliency literature does support a positive relationship be-
tween late life resilience and regulatory, interpersonal, and meaning
making strengths (Cabral, 2010; Gall et al., 2008; Lev-Wiesel & Amir,
2011; Moore et al., 2012; Palgi, 2016; Park et al., 2005; Sheikh &
Marotta, 2017; Shrira et al., 2011; Thornton & Perez, 2006; York,
2008). Despite conflicting findings, late life resiliency was positively
increased in individuals who demonstrated positive reframing and self-
labeling (Kimron et al., 2019; Shrira et al., 2011; Thornton & Perez,
2006), and the role of emotional awareness was positively associated
with an individual's ability to make positive changes after experiencing
a trauma (Cabral, 2010; Lev-Wiesel & Amir, 2011; Palgi, 2016; Thomas,
2018; Thornton & Perez, 2006).
Resilience and post-traumatic growth, although different, are two
commonly conflated concepts in the older adult literature. It is posited
that resilience throughout the lifespan may increase an individual's
capacity for post-traumatic growth after experiencing a traumatic event
(Garrido-Hernansaiz et al., 2017; Park et al., 2005). In fact, some re-
search suggests that individual's resilience increases or stabilizes with
age (Lurie-Beck et al., 2008; Seo & Lee, 2020; Shrira et al., 2014). As we
age and learn to successfully navigate adverse life experiences, we build
an increasingly large repertoire of tools we can use in similar future
experiences (Shrira et al., 2014). Therefore, it is possible that with age
and the ever-increasing number of skills we feel competent utilizing to
overcome adversity, our capacity for post-traumatic growth also
5
Aggression and Violent Behavior xxx (xxxx) xxxx
increases. Despite the limited amount of research that has been con-
ducted to date, findings regarding the role that resiliency and post-
traumatic growth play on PTSD in late life are mixed, while findings
regarding the role these concepts play on late life polyvictimization are
nonexistent.
4.1. Limitations and directions for future study
Despite the identification of the above studies, the literature
studying the relationships between resiliency or post-traumatic growth,
and polyvictimization or PTSD in late life is limited, and in some areas,
non-existent, which is a problem of increasing concern in the older
adult population (Heisler, 2017). This is particularly alarming, given
that the polyvictimization literature in childhood and midlife docu-
ments the additive effect that prolonged and repeated abuse can have
on individuals (Teaster, 2017). Yet despite the documentation of this
additive effect, prevalence rates of PTSD in older adults remain lower
than other age group. A number of mediating and moderating variables
have been proposed (i.e. symptom underreporting, cohort effects, psy-
chological symptoms reported as somatic complaints, subclinical
symptoms presentations in late life) (Cook et al., 2017; Dinnen et al.,
2015; Lapp et al., 2011; Kaiser et al., 2016; Reynolds et al., 2016)
however future research is needed to understand the direct impact of
these variables on the capacity for post-traumatic growth and the de-
creased prevalence rates of PTSD in late life.
Specifically, future research should place an increased importance
on developing ways to more accurately diagnose PTSD in late life and
increase research on strengths or protective factors (i.e., mastery and
social support) that may increase resilience when trauma does occur
(Hamby et al., 2016; Jackson & Hafemeister, 2013; Scheiman & Turner,
1998). By increasing researchers and psychologists' abilities to more
clearly delineate between older adults with and without PTSD, the re-
search in this field will be able to vastly expand. Beyond increasing
diagnostic accuracy, garnering a better understanding of the ways in
which resiliency and post-traumatic growth can help prevent post-
traumatic symptomatology in the older adult population is imperative.
Formulating this understanding will not only increase awareness but
may also lead to interventions that could minimizing the effects of
polyvictimization in late life.
5. Conclusion
Taking into consideration the mixed findings identified in the pre-
sent study, multiple relationships were identified that are in need of
more scientific attention. The aim of this scoping review was to better
understand the role of resiliency and post-traumatic growth in the late
life mental health of older adults who experienced PTSD or poly-
victimization. Although there is literature indicating a link between
resilience and post-traumatic growth, the relationship to date has not
been definitively defined. Additionally, our understanding of the im-
pact of resilience on post-traumatic stress disorder, although implied,
lacks a strong empirical foundation. As our understanding of PTSD in
this population grows, it will become increasingly important to un-
derstand the ways in which polyvictimization can impact protective
factors such as resilience and post-traumatic growth.
This review serves as a call to action, bringing to light the lack of
knowledge researchers currently have on the risk factors (i.e., poly-
victimization) and protective capabilities (i.e., resilience and post-
traumatic growth) associated with prevalence rates of PTSD in the older
adult population. Thus far, research is limited in its understanding of
how resilience and post-traumatic growth impact rates of PTSD and
polyvictimization in older adults. Future research should work to in-
crease our awareness of these relationships and help fill in the gaps in
current literature before a full systematic literature review is con-
ducted.
A.G. Nuccio and A.M. Stripling
Credit author statement
Alexandria Nuccio: Writing – Original draft preparation. Ashley
Stripling: Writing – Reviewing and editing.
Declaration of competing interest
We have no known conflict of interest to disclose.
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