PTSD Is a Chronic, Fluctuating Disorder Affecting the Mental Quality of Life in Older Adults

doi:10.1016/j.jagp.2013.01.064

The American Journal of Geriatric Psychiatry

Volume 22, Issue 1, January 2014, Pages 86-97

https://doi.org/10.1016/j.jagp.2013.01.064 Get rights and content

Objectives

Examine the longitudinal course of posttraumatic stress disorder (PTSD) in older adults and its influence on mental health quality of life (MHQoL).

Design

Evaluation performed at baseline, and 3 and 6 months postrandomization as part of a longitudinal trial.

Participants and settings

A total of 1,185 participants, with a mean (±SD) age of 73.53 (±5.98) years, at seven primary care sites (including five Veterans Affairs clinics), were divided into four groups, namely, no trauma (n = 661), trauma only (n = 319), partial PTSD (n = 114), and PTSD (n = 81), based on reports of trauma and associated PTSD symptoms.

Measurements

The prevalence of comorbid depression, anxiety, and alcohol use disorders, assessed using the Diagnostic and Statistical Manual, Fourth Edition, criteria and changes in MHQoL, as assessed by the Short Form–36 mental component score.

Results

At baseline, the PTSD group had higher frequencies of comorbid depression and anxiety disorders and worse MHQoL than the other groups. Both chronic (participants diagnosed with PTSD at all three assessments) and fluctuating (participants moving to or from one of the other groups) trajectories of course were observed during the follow-up period, which appeared to be separate from that of the comorbid disorders. Even after accounting for those comorbid disorders, PTSD had an independent association with poorer MHQoL at multiple time points, especially in men, whereas trauma without PTSD symptoms (trauma only) had better MHQoL.

Conclusions

PTSD had chronic and fluctuating courses, with negative effects on MHQoL, while partial PTSD might represent a transitional state, underscoring the need to better identify and treat PTSD at any phase in later life.

Section snippets

Background and Participants

PRISM-E was a randomized trial examining treatment engagement for geriatric (65 years or older) patients with depression, anxiety disorders, or at-risk drinking at 10 sites across the country.¹⁶ Patients attending primary care clinics who screened positive for one of PRISM-E's target conditions and without evidence of any significant cognitive impairment, defined as a Short Blessed Test score of greater than 16,¹⁷ underwent a detailed baseline evaluation after providing written informed consent.

Results

Demographic characteristics and the frequency of comorbid MH and medical problems in the four groups are presented in Table 1. The trauma only group included more whites, whereas minorities were more frequent in the other groups. The PTSD group had the highest frequencies of comorbid MDD, anxiety disorders, and no social support, and the lowest proportion of those with at-risk drinking. Each of the groups with a history of traumatic experiences had greater numbers of chronic medical problems

Conclusion

To the best of our knowledge, this investigation is the first that describes the short-term, 6-month course of PTSD and partial PTSD in older adults attending primary care clinics. Besides the trajectories of PTSD and partial PTSD in the absence of any PTSD-specific treatment, this study also examined the frequency of comorbid psychiatric disorders over time and the influence of multiple psychiatric conditions on the MHQoL over the same period. The course of PTSD was found to be distinct from

References (36)

R.H. Pietrzak et al.
Psychiatric comorbidity of full and partial posttraumatic stress disorder among older adults in the United States: results from wave 2 of the national epidemiologic survey on alcohol and related conditions
Am J Geriatr Psychiatry
(2012)
M.P. Chopra et al.
Importance of subsyndromal symptoms of depression in elderly patients
Am J Geriatr Psychiatry
(2005)
T.W. Meeks et al.
A tune in “a minor” can “b major”: a review of epidemiology, illness course, and public health implications of subthreshold depression in older adults
J Affect Disord
(2011)
J. Mylle et al.
Partial posttraumatic stress disorder revisited
J Affect Disord
(2004)
S.A.M. Rauch et al.
Posttraumatic stress, depression, and health among older adults in primary care
Am J Geriatr Psychiatry
(2006)
C. Beard et al.
Health-related quality of life across the anxiety disorders: findings from a sample of primary care patients
J Anxiety Disord
(2010)
S.R. Thorp et al.
Prolonged exposure therapy for older veterans with posttraumatic stress disorder: a pilot study
Am J Geriatr Psychiatry
(2012)
S. Mohamed et al.
Pharmacotherapy for older veterans diagnosed with posttraumatic stress disorder in Veterans Administration
Am J Geriatr Psychiatry
(2008)
The Diagnostic and Statistical Manual of Mental Disorders
(1994)
H. Glaesmer et al.
Traumatic experiences and post-traumatic stress disorder among elderly Germans: results of a representative population-based survey
Int Psychogeriatr
(2010)

E. Robins et al.

Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia

Am J Psychiatry

(1970)

C.L. Port et al.

A longitudinal and retrospective study of PTSD among older prisoners of war

Am J Psychiatry

(2001)

R. Yehuda et al.

Ten-year follow-up study of PTSD diagnosis, symptom severity and psychosocial indices in aging holocaust survivors

Acta Psychiatr Scand

(2009)

Z. Solomon et al.

Trajectories of PTSD: a 20-year longitudinal study

Am J Psychiatry

(2006)

A.J.E. Dirkzwager et al.

The longitudinal course of posttraumatic stress disorder among aging military veterans

J Nerv Ment Dis

(2001)

A. Spiro et al.

Posttraumatic stress disorder and health status: the Veterans Health Study

J Ambulatory Care Manage

(2006)

D. Mittal et al.

Impact of comorbid anxiety disorders on health-related quality of life among patients with major depressive disorder

Psychiatr Serv

(2006)

J.D. Richardson et al.

Posttraumatic stress disorder and health-related quality of life in pension-seeking Canadian World War II and Korean War veterans

J Clin Psychiatry

(2010)

Cited by (60)

The Safety and Efficacy of Psychedelic-Assisted Therapies for Older Adults: Knowns and Unknowns
2023, American Journal of Geriatric Psychiatry
Psychedelics and related compounds have shown efficacy for the treatment of a variety of conditions that are prevalent among older adults, including mood disorders, the psychological distress associated with a serious medical illness, post-traumatic stress disorder (PTSD), and prolonged grief disorder. Psychedelics also have properties that could help provide therapeutic benefits for patients with dementing disorders, as well as promoting personal growth among healthy older adults. This article focuses on psilocybin, a classic psychedelic, and MDMA, a substituted amphetamine with properties similar to classic psychedelics. Both act on the 5HT_2A receptor. Psychedelics can be safely administered to healthy adults in controlled conditions. However, both psilocybin and MDMA can increase blood pressure and heart rate, which could be a concern if used in older adults with cardiovascular disease. Very few older adults or patients with serious comorbidities have been included in clinical trials of psychedelics to date, raising the question of how generalizable study results are for the patients that most geropsychiatrists will be treating. Research on the neurophysiologic and mechanistic effects of psychedelics in older adults could also provide insights into the aging brain that could have clinical applications in the future. Given the potential of psychedelic compounds to benefit older adults, more research is needed to establish safety and efficacy among older adults, particularly those with multi-morbidity.
Qualitative Analysis of a Supervised Exercise Program for Older Veterans With PTSD
2021, American Journal of Geriatric Psychiatry
Older veterans with post-traumatic stress disorder (PTSD) experience substantial physical and mental health challenges. Given the well-known and wide-reaching benefits of exercise, exploring the impact of interventions designed specifically for this population would be valuable. As such, the present study explored perspectives from older veterans with PTSD who participated in Warrior Wellness, a 12-week supervised exercise intervention designed for older veterans with PTSD. This study was aimed at evaluating 1) facilitators of engagement, 2) perceived benefits from the intervention, and 3) recommendations about possible modifications to the intervention.
Qualitative study.
Face-to-face semistructured interviews conducted after the Warrior Wellness trial was completed.
Fifteen veterans (100% male, 93% African American or Black, 100% non-Hispanic or Latinx, average age = 68.7 years) who completed the Warrior Wellness exercise program.
Semistructured interviews were conducted using an interview guide that assessed veterans’ experience in Warrior Wellness and recommendations for future intervention modifications. Interviews were subsequently transcribed and analyzed by thematic analysis.
Shared experience, program features, camaraderie during workouts, and accountability emerged as facilitators of engagement. Perceived benefits spanned physical health, mental health, and behavioral domains. Finally, veterans provided several suggestions for modifying the intervention such as increasing its duration, adding a nutritional component, and including significant others in enrollment.
This study offers valuable insights into the intervention and interpersonal factors that veterans view as important for their engagement in exercise, the perceived benefits of exercise, and the ways in which interventions designed for this population can be refined.
Posttraumatic stress disorder and loneliness are associated over time: A longitudinal study on PTSD symptoms and loneliness, among older adults
2021, Psychiatry Research
Citation Excerpt :
Thus, the association between loneliness and PTSD over time may be reciprocal (see Figure 1 for an illustration of the theoretical pathways explaining the longitudinal relationship between loneliness and PTSD symptoms). Although symptoms of PTSD are chronic and stable for some individuals; they have been found to fluctuate over time for others in later life (Chopra et al., 2014). Symptoms of PTSD have also been found to re-emerge in later life, possibly due to age-related normative events such as retirement, bereavements, and worsening physical health (Pless Kaiser et al., 2019).
Loneliness has a pernicious effect on mental health in later life and is likely to have a bidirectional relationship with psychopathology. However, longitudinal research examining loneliness and posttraumatic stress symptoms among older adults is scarce. This study aimed to examine the longitudinal relationship between different types of loneliness (social and emotional) and posttraumatic stress symptoms. Using two waves of an older adult sample (n = 1,276) from the Longitudinal Aging Study Amsterdam (LASA), this longitudinal relationship was examined using a multivariate two wave-latent change score (2W-LCS) model. There were significant, however, very small increases in both posttraumatic stress symptoms and emotional loneliness over time, whereas, average social loneliness scores did not significantly increase/decrease over time. Changes in both social (β = .16) and emotional loneliness (β = .15) were associated with small changes in posttraumatic stress symptoms, consistent with the existence of a longitudinal association between the constructs, net of covariate effects. Results provide evidence of the existence of a longitudinal association between subtypes of loneliness and posttraumatic stress symptoms, among older adults. Results have implications for clinicians who should identify individuals at risk of developing posttraumatic stress symptoms, and for the theory of both posttraumatic stress disorder and loneliness.
Determining the median effective dose of prolonged exposure therapy for veterans with posttraumatic stress disorder
2020, Behaviour Research and Therapy
Citation Excerpt :
To establish a baseline, PCL scores up to one year prior to first PE session were collected. Although the PCL has displayed moderate to high temporal stability when measured at one year gaps (Ahmadian et al., 2020), PTSD symptoms can fluctuate over time (Chopra et al., 2014), potentially impacting results. To maximize the sample and reduce sampling bias, two versions of the PCL were combined using transformation and results are presented based on the PCL-IV scale.
Prolonged exposure therapy (PE) is an effective treatment for posttraumatic stress disorder (PTSD). Identifying metrics of treatment response can guide treatment delivery. The median effective dose represents the number of sessions at which there is a 50% probability of clinically meaningful improvement (i.e., 10-point reduction in PTSD checklist). The goal of the current study was to investigate the median effective dose of PE. We identified a cohort of Iraq and Afghanistan war veterans who received psychotherapy for PTSD in the Veterans Health Administration between 2001 and 2017. From this cohort, 10,234 veterans who received PE (as identified using natural language processing) and had ≥2 PTSD symptom measures were included in analyses. To determine how the number of PE sessions and covariates affected clinically meaningful improvement, we utilized a Cox proportional hazards regression, followed by Kaplan-Meier curves to determine the median effective dose. The median effective dose of PE was four sessions. Although some covariates were found to be statistically significant predictors of clinically meaningful improvement (e.g., age, gender, PTSD medications, and depressive disorder comorbidity), these effects were small. Clinicians and patients should consider evaluating treatment response after four sessions to determine preliminary effectiveness of PE.
Patterns of comorbidity associated with ICD-11 PTSD among older adults in the United States
2020, Psychiatry Research
Little research has been conducted on posttraumatic stress disorder (PTSD) comorbidity among older adults regarding the description of PTSD in the 11^th version of the International Classification of Diseases (ICD-11). This study sought to provide evidence of a dimensional model of psychopathology using the ‘Hierarchical Taxonomy of Psychopathology’ (HiTOP) model as a theoretical framework to explain patterns of ICD-11 PTSD comorbidity. Distinct patterns of ICD-11 PTSD comorbidity among a nationally representative sample (n = 530) of adults aged 60 years and older from the United States were examined using latent class analysis (LCA). Covariates associated with comorbidity classes were assessed through multinomial logistic regression. ICD-11 PTSD was highly comorbid with other psychopathologies. LCA results favoured a two-class solution. Class 1 (71.7%) was characterised by moderate probabilities for major depressive disorder and alcohol use disorder; Class 2 (28.3%) was characterised by a moderate-high probability of general psychopathology and was associated with lower social support, spousal/partner physical abuse, and history of attempted suicide. PTSD was highly comorbid with other disorders among older adults. Distinct patterns of PTSD comorbidity exist among this cohort and these findings can aid clinicians and researchers in understanding and predicting maladaptive responses to trauma and associated psychopathology.
Emotion dysregulation is associated with increased prospective risk for chronic PTSD development
2020, Journal of Psychiatric Research
While emotion dysregulation is associated with many psychological disorders, including posttraumatic stress disorder (PTSD), it remains uncertain whether pre-existing emotion dysregulation increases individual risk for prospectively developing PTSD in the aftermath of trauma exposure. Thus, the objective of the current study was to determine whether emotion dysregulation could prospectively predict the development of chronic PTSD symptoms following a traumatic event above and beyond other known associated factors, including depressive symptoms, baseline PTSD symptoms, total traumas experienced, and exposure to interpersonal trauma. Participants (N = 135) were recruited from the emergency department (ED) at Grady Memorial Hospital in Atlanta and follow-up assessments were conducted at 1-, 3-, 6-, and 12-months following trauma exposure. Latent Growth Mixture Modeling was used to identify PTSD symptom trajectories based on symptoms assessed at 1, 3, 6, and 12 months; three trajectories emerged: “chronic”, “recovery”, and “resilient”. For the present study, probability of chronic PTSD symptoms was used as the outcome variable of interest. Linear regression modeling showed that emotion dysregulation was significantly associated with probability of developing chronic PTSD symptoms (p = 0.001) and accounted for an additional 7% of unique predictive variance when controlling for trauma exposure, baseline PTSD, and depressive symptoms. Our findings suggest that emotion dysregulation can be used as both a predictor of chronic PTSD and as a treatment target. Thus, identifying individuals with high levels of emotion dysregulation at the time of trauma and implementing treatments designed to improve emotion regulation could aid in decreasing the development of chronic PTSD among these at-risk individuals.

View all citing articles on Scopus

View full text

Regular Research ArticlePTSD Is a Chronic, Fluctuating Disorder Affecting the Mental Quality of Life in Older Adults

Objectives

Design

Participants and settings

Measurements

Results

Conclusions

Section snippets

Background and Participants

Results

Conclusion

Am J Geriatr Psychiatry

Am J Geriatr Psychiatry

J Affect Disord

J Affect Disord

Am J Geriatr Psychiatry

J Anxiety Disord

Am J Geriatr Psychiatry

Am J Geriatr Psychiatry

The Diagnostic and Statistical Manual of Mental Disorders

Traumatic experiences and post-traumatic stress disorder among elderly Germans: results of a representative population-based survey

Int Psychogeriatr

Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia

Am J Psychiatry

A longitudinal and retrospective study of PTSD among older prisoners of war

Am J Psychiatry

Ten-year follow-up study of PTSD diagnosis, symptom severity and psychosocial indices in aging holocaust survivors

Acta Psychiatr Scand

Trajectories of PTSD: a 20-year longitudinal study

Am J Psychiatry

The longitudinal course of posttraumatic stress disorder among aging military veterans

J Nerv Ment Dis

Posttraumatic stress disorder and health status: the Veterans Health Study

J Ambulatory Care Manage

Impact of comorbid anxiety disorders on health-related quality of life among patients with major depressive disorder

Psychiatr Serv

Posttraumatic stress disorder and health-related quality of life in pension-seeking Canadian World War II and Korean War veterans

J Clin Psychiatry

Regular Research Article
PTSD Is a Chronic, Fluctuating Disorder Affecting the Mental Quality of Life in Older Adults