Caring for Elderly with PTSD


What is PTSD?

Posttraumatic Stress Disorder is a mental health problem caused by experiencing or witnessing a life-threatening event. This might include combat, a natural disaster, a car accident or sexual assault. It can be prevented by avoiding stress and receiving social support. Signs of PTSD include reliving an event (through memories, flashbacks, nightmares), avoiding situations that remind you of the event, and having more negative feelings and hyperarousal (jittery and alert).

Treatment Options

If your loved one is suffering from PTSD, you can choose to seek psychotherapy (counseling), medication, or a combination of both. Trauma-focused psychotherapy centers around the memory of the traumatic event, and can include Cognitive Processing Therapy (CPT), Prolonged Exposure, and Eye Movement Desensitization and Reprocessing (EMDR). If you choose to use medications, your doctor will most likely prescribe SSRIs (selective serotonin reuptake inhibitors) or SNRIs ((serotonin-norepinephrine reuptake inhibitors). Though they’re typically used for depression, they also work for PTSD.

ptsd therapy

The Elderly and PTSD

Increased Symptoms

Sometimes, symptoms of PTSD can increase with age. This might be due to a role change, function loss, and an inability to engage in avoidance-based coping strategies (ie: alcohol). Stressors like retirement, health problems, reduced income, loss of loved ones and cognitive impairment can all enhance PTSD. The elderly are also less likely to identify problems from a psychological framework. Older veterans might assume their problems are related to the aging process rather than events that happened in their past. Since PTSD is a relatively new discovery, many older people who underwent traumatic experiences in their younger days had PTSD that went undiagnosed.

caring for elderly with ptsd

Health Correlations

Older adults who experienced greater lifetime trauma exposure were found to have poorer self-rated health, more chronic health problems and more functional difficulties. Some studies have even found a correlation between combat veterans with trauma experience and arterial disorders, gastrointestinal issues, dermatological problems and musculoskeletal disorders. PTSD is often accompanied by mood disorders, anxiety disorders and substance abuse among the elderly. PTSD may also be a risk factor for dementia (two times as likely).

Precautions

When accessing an elderly patient with PTSD, it’s recommended that you conduct a full Mental Status Examination with a cognitive screening. This is especially important for older adults who are inattentive to appearance or have a bad memory. You’ll also need to conduct a routine assessment of trauma and related symptoms and keep an eye out for complaints of sleep difficulties, gastrointestinal issues, cognitive difficulties or stress. Older PTSD patients are less likely to describe emotional difficulties, such as depression or anxiety. You’ll need to keep in mind that older and younger veterans are particularly susceptible to suicide. Before you begin trauma-focused treatment, you should let the provider know if the patient has a significant cardiac or respiratory problem. According to the U.S. Department of Veterans Affairs, the elderly may be more sensitive to medication side effects. They’re also managing more co-occurring medical issues and medications, creating several variables that could be affecting the patient. To combat risk, you should start with a low dose when introducing new medication.

How to Help Someone with PTSD

If you’re caring for an elderly person with PTSD, there are some ways you can help them cope with their problems and move forward. For one, you shouldn’t try to force your loved one into talking. For many, talking about their traumatic event only makes things worse. Just make it known to them that you’re always there to listen should they need someone to talk to, and don’t give cookie-cutter responses like ‘everything is going to be okay’. You can also set as good example by remaining calm and relaxed. Do your research, so you can understand what it’s like living with PTSD. Don’t place blame on them for something that’s beyond their control, and don’t minimize their traumatic experience. It’s important to create routines for your loved one as well. Creating a daily schedule can restore stability and security to those with PTSD. Many of those affected by PTSD feel their future is limited, so you should talk with them about future plans to combat that feeling. Try to keep your promises, and encourage loved ones to seek help through a support group. These are the best ways to help someone with PTSD.

talking with elderly PTSD

Managing Triggers

A trigger is something that reminds someone with PTSD of the trauma they went through. This sets off a PTSD symptom, like a flashback. A trigger might be something like seeing a person that was involved in the event or hearing loud noises that sound like gunfire. Internal feelings can also be triggers. Common internal triggers include physical discomfort, strong emotions and strong feelings toward family members

Managing Angry Outbursts

Those who suffer from PTSD normally experience physical and emotional stress daily. This leads to sleep problems, which leads to lack of sleep, which leads to exhaustion. Think about how cranky you can get when you haven’t had enough sleep. It’s like that, but every day. Many use anger to cope with the grief, helplessness and guilt that comes from PTSD. You’ll need to watch for signs of anger, so you can defuse the situation before it blows up. If outbursts do occur, keep calm and give them space. Try to see how you can help first, but contact the authorities if the situation gets out of hand.

PTSD Service Dogs

PTSD service dogs are one of the fastest-growing solutions for treating PTSD. Programs like Pawsitivity and Canines 4 Hope help prevent the 22 veteran suicides that take place every day. In fact, 82% of those with a PTSD diagnosis reported symptom reduction after getting a service dog. Plus, 40% reported a decrease in the use of medication. Studies have shown that owning a service dog can lessen the perception of physical pain, lower aggression, improve social interaction, make daily living more manageable, lower blood pressure/heart rate, deplete loneliness and ease anxiety/depression. These dogs are picked based on their natural traits and then trained to assist those who suffer from PTSD. They can assist in a medical crisis, assist with emotional overloads, pick up on signaling behavior, and keep crowds away when their owner is having flashbacks. PTSD service dogs can also adjust serotonin levels. Service dogs force those with PTSD to leave their home (for walks), they wake the handler when night terrors occur, and provide an alternate focus when the handler is experiencing sensory overload.

ptsd service dog

PTSD Flashbacks

If someone with PTSD is experiencing a flashback, they may lose awareness of everything going on around them. They may also undergo dissociation, an experience where a person feels disconnected from themselves and their surroundings. Things may begin to look fuzzy for them. To prevent flashbacks, you should try to catch the early symptoms and revisit what brought an earlier episode on. Once you’ve identified triggers, you can combat flashbacks by turning on loud music to redirect your attention, gripping a piece of ice, sniffing strong peppermint, biting into a lemon, and taking inventory of your surroundings. If you’re loved on is about to be pulled into a flashback, tell them to identify the colors they see around the room, count the pieces of furniture or list off noises they hear. PTSD flashbacks can be scary for both the one experiencing them and the one’s witnessing the flashback take place. These techniques should help PTSD patients snap back to reality.

PTSD Statistics

  • 70-90% of adults over the age of 65 have dealt with at least one potentially traumatic event during their lifetime.
  • Trauma is more prevalent in older men than older women.
  • Between 1.5% and 4% of adults over 60 have PTSD.
  • 7%-15% of older adults have sub-clinical levels of PTSD.
  • One type of interpersonal trauma that’s common among older women (ages 45-70) is intimate partner violence.

Veterans and PTSD

85% of older male veterans have experienced lifetime exposure to traumatic events.  One study found that 53% of male combat veterans and ex-POWs of WWI and Korea had a lifetime prevalence of PTSD and 29% have current PTSD. Younger veterans are more likely to develop PTSD than older veterans. Older veterans tend to deal more with appetite, sleep or memory issues rather than PTSD symptoms. Older veterans also report less depression, hostility and guilt compared to younger Veterans. If your loved one experienced trauma later on in life, they’ll go through more avoidance, sleep problems, and hyperarousal. You can read through the stories page to learn more about our veterans and their families.

veterans and ptsd

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