Knowledge regarding the assessment and treatment of posttraumatic stress disorder in older adults continues to be limited in both psychological research and practice. This article provides a summary of this literature. In particular, the psychometric properties of several posttraumatic stress disorder assessment measures in their use with older individuals are reviewed. Although the evidence base on effective treatments for posttraumatic stress disorder in older adults is virtually nonexistent, this article highlights the innovative clinical endeavors that have been conducted in this regard. Explicit suggestions for best practices are made.
Foa EB, Keane TM, Friedman MJ. Effective treatments for PTSD: Practice Guidelines From the International Society for Traumatic Stress Studies. New York, NY: Guilford, 2000.
2.
Wilson JP, Keane TM, eds. Assessing psychological trauma and PTSD. 2nd ed.New York, NY: Guilford, 2004.
3.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed, text revision. Washington, DC: American Psychiatric Association, 2000.
4.
Averill PM, Beck GJ. Posttraumatic stress disorder in older adults: a conceptual review. J Anxiety Disord. 2000;14:133-156.
5.
Cook JM, Niederehe G.Trauma in older adults. In: Friedman MJ, Keane TM, Resick PA, eds. PTSD Science & Practice: A Comprehensive Handbook, In Press.
6.
Falk B, Hersen MH, Van Hasselt V.Assessment of post-traumatic stress disorder in older adults: a critical review. Clin Psychol Rev. 1994;14:383-415.
7.
United Nations. Population division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2002 Revision and World Urbanization Prospects, 2003.Available at: http://esa.un.org/unpp. Accessed January 1, 2004.
8.
U.S. Census Bureau. National Population Projections 2004. Available at: http://www.census.gov/population/www/projections/natsum-T3.html. Accessed October 1, 2004.
9.
Gerontological Society of America Task Force on Minority Issues in Gerontology. Minority Elders: Five Goals Toward Building a Public Policy Base. Washington, DC: Gerontological Society of America; 1994.
10.
Kessler RC. Posttraumatic stress disorder: the burden to the individual and to society. J Clin Psychiatry. 2000;61(suppl 5):4-12.
Spiro A, Schnurr PP, Aldwin CM. Combat-related posttraumatic stress disorder symptoms in older men. Psychol Aging. 1994;9:17-26.
13.
Cook JM, Thompson R, Coyne JC, Sheikh J.Algorithm versus cut-point derived PTSD in ex-prisoners of war. J Psychopathol Behav Assess. 2003;25:267-271.
14.
Engdahl BE, Eberly RE, Blake JD. Assessment of posttraumatic stress disorder in World War II veterans. Psychol Assess. 1996;8:445-449.
15.
Hyer L, Summers MN, Boyd S, et al.Assessment of older combat veterans with the Clinician-Administered PTSD Scale. J Trauma Stress. 1996;9:587-593.
16.
Hyer L, Walker C, Swanson G, et al.Validation of PTSD measures for older combat veterans. J Clin Psychol. 1992;48:579-589.
17.
Neal LA, Hill N, Hughes J, et al.Convergent validity of measures of PTSD in an elderly population of former prisoners of war. Int J Geriatr Psychiatry. 1995;10:617-622.
18.
Query WT, Megran J, McDonald G.Applying posttraumatic stress disorder MMPI subscale to World War II POW veterans. J Clin Psychol. 1986;42:315-317.
19.
Summers MN, Hyer L, Boyd S, Boudewyns PA. Diagnosis of later-life PTSD among elderly combat veterans. J Clin Geropsychol. 1996;2:103-115.
20.
Sutker PB, Bugg F, Allain AN. Psychometric prediction of PTSD among POW survivors. Psychol Assess. 1991;3:105-110.
21.
Blake DD, Weathers FW, Nagy LM, et al.The development of a clinician-administered PTSD scale. J Trauma Stress. 1995;8:75-90.
22.
First M, Williams J, Spitzer R.DTREE: The Electronic DSM-III. Washington, DC: Multihealth Systems, American Psychiatric Press; 1988.
23.
Keane TM, Caddell JM, Taylor KL. Mississippi Scale for Combat-Related Posttraumatic Stress Disorder: Three studies in reliability. J Consult Clin Psychol. 1988;56:85-90.
24.
Keane TM, Malloy PF, Fairbank JA. Empirical development of an MMPI subscale for the assessment of combat-related post-traumatic stress disorder. J Consult Clin Psychol. 1984;52:888-891.
25.
Horowitz M, Wilner N, Alvarez W.Impact of Event Scale: A measure of subjective distress. Psychosom Med. 1979;41:209-218.
26.
Saunders BE, Arata CM, Kilpatrick DG. Development of a crime related post-traumatic stress disorder scale for women within the SCL-90-Revised. J Trauma Stress. 1990;3:435-448.
27.
Keane TM, Fairbank JA, Caddell JM, et al.Clinical evaluation of a measure to assess combat exposure. Psychol Assess J Consult Clin Psychol. 1989;1:53-55.
28.
Spitzer RL, Williams JB. Structured Clinical Interview for DSMIII-R Non-Patient Edition. New York, NY: New York State Psychiatric Institute, Biometrics Research; 1986.
29.
Page WF. The Health of Former Prisoners of War: Results From the Medical Examination Survey of Former POWs of WWII and the Korean Conflict. Washington, DC: National Academy Press, 1992.
30.
Spielberger CD, Gorsuch RL, Lushene RE. STAI: Manual for the State Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press; 1970.
31.
Weathers FW, Litz BT, Herman DS, et al.The PTSD Checklist (PCL): reliability, validity and diagnostic utility. Paper presented at: meeting of the International Society for Traumatic Stress Studies; October 1993; San Antonio, Tex.
32.
Zelst WH, de Beurs E, Beekman ATF, et al.Criterion validity of the self-rating inventory for posttraumatic stress disorder (SRIP) in the community of older adults. J Affect Disord. 2003;76:229-235.
33.
Hovens JE, van der Ploeg HM, Bramsen I, et al.The development of the self-rating inventory for posttraumatic stress disorder. Acta Psychiatr Scand. 1994;90:172-183.
34.
Wittchen H.-U.Reliability and validity studies of the WHO: composite international diagnostic interview (CIDI): a critical review. J Psychiatr Res. 1994;28:57-84.
35.
Fulmer T, Birkenhauser D.Elder mistreatment assessment as a part of everyday practice. J Gerontol Nurs. 1992;18:42-45.
36.
American Medical Association. Diagnostic and Treatment Guidelines on Elder Abuse and Neglect. Chicago, Ill: American Medical Association; 1992.
37.
Briere J.Psychological Assessment of Adult Posttraumatic States: Phenomenology, Diagnosis, and Measurement. Washington, DC: American Psychological Association; 2004.
38.
Frueh BC, Elhai JD, Kaloupek DG. Unresolved issues in the assessment of trauma exposure and posttraumatic reactions. In: Rosen GM, ed. Posttraumatic Stress Disorder: Issues and Controversies. New York, NY: Wiley; 2004:63-84.
39.
Stamm BH. Measurement of Stress, Trauma, and Adaptation. Lutherville, Md: Sidran Press; 1996.
40.
VA National Center for PTSD. Available at: http://www.ncptsd.org/publications/assessment. Accessed April 5, 2004.
41.
Acierno R, Brady KL, Gray M, et al.Psychopathology following interpersonal violence: a comparison of risk factors in older and younger adults. J Clin Geropsychol. 2002;8:13-23.
42.
Davidson JRT, Kudler HS, Sunders WB, Smith RD. Symptom and comorbidity patterns in World War II and Vietnam veterans with posttraumatic stress disorder. Compr Psychiatry. 1990;31:162-170.
43.
Fontana A, Rosenheck R.Traumatic war stressors and psychiatric symptoms among World War II, Korean, and Vietnam War veterans. Psychol Aging. 1994;9:27-33.
44.
Elder GH Jr.Children of the Great Depression: Social Change in Life Experience. Boulder, Colo: Westview Press; 1999.
45.
Wolkenstein BH, Sterman L.Unmet needs of older women in a clinical population: the discovery of possible long-term sequelae of domestic violence. Prof Psychol Res Pract. 1998;29:341-348.
46.
Allers CT, Benjack KJ, Allers NT. Unresolved childhood sexual abuse: are older adults affected?J Couns Dev. 1997;71:14-17.
47.
Bechtle-Higgins A, Follette VM. Frequency and impact of interpersonal trauma in older women. J Clin Geropsychol. 2002;8:215-226.
48.
Hankin CS. Treatment of older adults with posttraumatic stress disorder. In: Maercker A, ed. Treatment of PTSD. New York, NY: Springer; 1997:357-384.
49.
Port CL, Engdahl B, Frazier P.A longitudinal and retrospective study of PTSD among older POWs. Am J Psychiatry. 2001;158:1474-1479.
50.
Clower MW, Snell FI, Liebling DS, Padin-Rivera E.Senior Veterans PTSD Workbook: A Personal Journey. Cleveland, Ohio: Department of Veterans Affairs; 1998.
51.
Hoppe KD. Psychotherapy with concentration camp survivors. In: Krystal H, ed. Massive Psychic Trauma. New York, NY: International University Press; 1968:204-219.
52.
Danieli Y.The aging survivor of the Holocaust. Discussion: on the achievement of integration in aging survivors of the Nazi Holocaust. J Geriatr Psychiatry. 1981;15:191-215.
53.
Müller U, Barash-Kishon R.Psychodynamic-supportive group therapy model for elderly holocaust survivors. Int J Group Psychother. 1998;48:461-475.
54.
Erlich S.Short-term group therapy with holocaust survivors and the second generation. Group. 2002;26:163-171.
55.
Boehnlein JK, Sparr LF. Group therapy with World War II ex-POWs: long term post-traumatic adjustment in a geriatric population. Am J Psychother. 1993;47:273-282.
56.
Hyer L, Swanson G, Lefkowitz R, et al.The application of the cognitive behavioral model to two older stressor groups. Clin Gerontol. 1990;9:145-190.
57.
Lipton MI, Schaffer WR. Post-traumatic stress disorder in the older veteran. Mil Med. 1986;151:522-524.
58.
Molinari V, Williams W.An analysis of aging World War II POWs with PTSD: implications for practice and research. J Geriatr Psychiatry. 1995;28:99-114.
59.
Snell FI, Padin-Rivera E.Group treatment for older veterans with post-traumatic stress disorder. J Psychosoc Nurs. 1997;35:10-16.
60.
Clower MW, Snell FI, Liebling DS, Padin-Rivera E.Senior Veterans Program: A Treatment Program for Elderly Veterans With War-Related Post-Traumatic Stress Disorder: Therapist Notes. Cleveland, Ohio: Department of Veterans Affairs; 1996.
61.
Foy DW, Glynn SM, Schnurr PP, et al.Group therapy. In: Foa EB, Keane TM, Friedman MJ, eds. Effective Treatments for PTSD: Practice Guidelines From the International Society for Traumatic Stress Studies. New York: Guilford; 2000:155-175.
62.
Tyra PA. Helping elderly women survive rape: Using a crisis framework. J Psychosoc Nurs. 1996;34:20-25.
63.
Vinton L.Battered women’s shelters and older women: The Florida Experience. J Fam Violence. 1992;7:63-72.
64.
Booth BB, Bruno AA, Marin R.Psychological therapy with abused and neglected patients. In: Baumhover LA, Beall SC, eds. Abuse, Neglect, and Exploitation of Older Persons: Strategies for Assessment and Intervention. Baltimore, Md: Health Professions Press; 1996:185-203.
65.
Nahmiash D, Reis M.Most successful intervention strategies for abused older adults. J Elder Abuse Neglect. 2000;1:53-70.
66.
Ramsey-Klawsnik H.Assessing physical and sexual abuse in health care settings. In: Baumhover LA, Beall SC, eds. Abuse, Neglect, and Exploitation of Older Persons: Strategies for Assessment and Intervention. Baltimore, Md: Health Professions Press; 1996:67-88.
67.
Mosqueda L, Burnight K, Liao S, Kemp B.Advancing the field of elder mistreatment: a new model for integration of social and medical services. Gerontologist. 2004;44:703-708.
68.
Lew L.Elderly Cambodians in Long Beach: creating cultural access to health care. J Cross Cult Gerontol. 1991;6:199-203.
69.
Thompson LW, Gallagher-Thompson D, Dick LP. Cognitive-Behavioral Therapy for Late Life Depression: A Therapist Manual. Palo Alto, Calif: Older Adult and Family Center, Veterans Affairs Palo Alto Health Care System; 1995.
70.
Swanson GS, Frey J, Hyer LA. The strategic approach to unfreeze symptoms of PTSD. Clin Gerontol. 1989;8:83-86.
71.
Foa EB, Kozak MJ. Emotional processing of fear: exposure to corrective Information. Psychol Bull. 1986;99:20-35.
72.
Foa EB, Rothbaum BO. Treating the Trauma of Rape: Cognitive Behavioral Therapy for PTSD. New York: Guilford; 1998.
73.
Hyer LA, Woods MG. Phenomenology and treatment of trauma in later life. In: Follette VM, Ruzek JI, Abueg FR, eds. Cognitive-Behavioral Therapies for Trauma. New York, NY: Guilford; 1998:383-414.
74.
Kruse A, Schmitt E.Reminiscence of traumatic experiences in (former) Jewish emigrants and extermination camp survivors. In: Maercker A, Schützwohl M, Solomon Z, eds. Post-Traumatic Stress Disorder. A Lifespan Developmental Perspective. Seattle, Wash: Hogrefe & Huber; 1999:155-176.
75.
Russo SA, Hersen M, Van Hasselt VB. Treatment of reactivated post-traumatic stress disorder: Imaginal exposure in an older adult with multiple traumas. Behav Modif. 2001;25:94-115.
76.
Shapiro F.Eye movement desensitization: A new treatment for post-traumatic stress disorder. J Behav Ther Exp Psychiatry. 1989;20:211-217.
77.
Shapiro F. EyeMovement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures. 2nd ed.New York: Guilford; 2001.
78.
Thomas R, Gafner G.PTSD in an elderly male: Treatment with Eye Movement Desensitization and Reprocessing (EMDR). Clin Gerontol. 1993;14:57-59.
79.
Hyer LA. Use of EMDR in a “dementing” PTSD survivor. Clin Gerontol. 1995;16:70-73.
80.
Herbert JD, Lilienfeld SO, Lohr JM, et al.Science and pseudo-science in the development of eye movement desensitization and reprocessing: implications for clinical psychology. Clin Psychol Rev. 2000;20:945-971.
81.
Hyer LA, Brandsma JM. EMDR minus eye movements equals good psychotherapy. J Trauma Stress. 1997;10:515-522.
82.
Butler RN. The life review. An interpretation of reminiscence in the aged. Psychiatry. 1963;26:65-76.
83.
Maercker A.Life-review technique in the treatment of PTSD in elderly patients: rationale and three single case studies. J Clin Geropsychol. 2003;3:239-249.
84.
McInnis-Dittrich K.Adapting life review therapy for elderly female survivors of childhood sexual abuse. Families in Society. 1996;77:166-173.
85.
Coleman PG. Creating a life story. The task of reconciliation. Gerontologist. 1999;39:133-139.
86.
Cook JM, Schnurr PP, Foa EB. Bridging the gap between post-traumatic stress disorder research and clinical practice: the example of exposure therapy. Psychotherapy, In Press.
87.
Gold SN. Not Trauma Alone: Therapy for Child Abuse Survivors in Family and Social Context. New York, NY: Brunner-Routledge; 2000.
88.
Cook JM, Ruzek JI, Cassidy EL. Post-traumatic stress disorder and cognitive impairment in older adults: awareness and recognition of a possible association. Psychiatric Serv. 2003;54:1223-1225.
89.
Kasl-Godley J, Gatz M.Psychosocial intervention for individuals with dementia: an integration of theory, therapy, and a clinical understanding of dementia. Clin Psychol Rev. 2000;20:755-782.
90.
Menorah Park Center for Senior Living. Painful Memories: Understanding the Special Needs of Holocaust Survivors [video-tape]. Cleveland, Ohio: Menorah Park Center for Senior Living; 1993.
91.
Gallagher-Thompson D, Thompson LW. Applying cognitive-behavioral therapy to the psychological problems of later life. In: Zarit SH, Knight BG, eds. A Guide to Psychotherapy and Aging: Effective Clinical Interventions in a Life-Stage Context. Washington, DC: American Psychological Association; 1996:61-82.
92.
American Psychological Association Working Group on the Older Adult. What practitioners should know about working with older adults. Profess Psychol Res Pract. 1998;29:413-427.
93.
American Psychological Association. Guidelines for Psychological Practice With Older Adults. Washington, DC: American Psychological Association; 2003.
94.
Boudewyns PA, Hyer LA, Klein DS, et al.Lessons learned in the treatment of chronic, complicated posttraumatic stress disorder. In: Miller TW, ed. Clinical Disorders and Stressful Life Events. Madison, Conn: International Universities Press; 1997:353-378.
95.
Schnurr PP, Friedman MJ, Foy DW, et al.Randomized trial of trauma-focused group therapy for posttraumatic stress disorder. Arch Gen Psychiatry. 2003;60:481-489.
96.
Hyer L.The effects of trauma: dynamics and treatment of PTSD in the elderly. In: Duffy M, ed. Handbook of Counseling and Psychotherapy With Older Adults. New York, NY: Wiley; 1999:539-560.
97.
Hyer LA, Sohnle SJ. Trauma Among Older People: Issues and Treatment. Philadelphia, Pa: Brunner-Routledge; 2001.
