Posttraumatic stress disorder in the elderly: a review

Posttraumatic disorder (PTSD) in elderly persons impairs their ability to deal with subsequent life stress and to negotiate the developmental stages of late life successfully. It can stem from trauma at any point in life. Symptoms may be persistent or intermittent, and the disorder may be time-limited or chronic. Increasing severity of trauma and premorbid psychiatric illness predispose to the development of PTSD, and certain personality traits and good psychosocial support protect against it. Elderly individuals do not appear more predisposed than young persons to develop PTSD, and symptoms of the disorder are similar across age groups: reexperiencing the trauma, avoidance, and hyperarousal. Dysfunctions of the adrenergic system and the hypothalamic-pituitary-adrenal axis have been implicated in the neurobiology of PTSD, although there is no current evidence that the changes seen in these systems with aging affect the development or presentation of PTSD in older individuals. Antidepressants, group therapy, and cognitive-behavioral therapy are presently the mainstays of treatment, although to date no systematic and controlled research has been done on the treatment of PTSD in this age group.