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PTSD in late life and terminal illness

An overview of PTSD in the context of later life and life-limiting illness--assessment, diagnosis, and treatment approac
by

Michael Palmer, Ph.D

on 22 March 2016

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Transcript of PTSD in late life and terminal illness

PTSD... ...in Late Life and Terminal Illness Avoidance
Thoughts and feelings
Talking about event
Reminders and triggers
Numbing
Detachment Arousal
Hypervigilance
Angry outbursts
Sleep disruption
Exaggerated startle Re-Experiencing
Intrusive memories
Nightmares
Flashbacks Criterion A (Traumatic) Event-
"the person witnessed, or was confronted with an event that involved actual or threatened death or serious injury...response involved intense fear, helplessness, or horror" (DSM-IV) "...significant distress or impairment Presentations...
Chronic
Late-onset (early trauma)
New trauma
PTSD in dementia Prevalence-Incidence
66% of older adults experience trauma (Rauch et al., 2006)
11.8-15.6% develop PTSD symptoms
0.9-1.6% meet PTSD dx criteria
Other studies have reported as high as 24% (Quereshi, Kimbrell, Pyne, et al., 2010)
PTSD dx 2x more likely to develop dementia Impact of PTSD on Older Adults
Greater disability
Increased bed days
Lower life satisfaction
Suboptimal treatment
Less satisfaction with providers
(van Zelst et al., 2006)
Increased risk of substance use
Increased suicide risk
Higher comorbid illness Late-Onset PTSD
Life transitions
Working, physically active
New stressors
Losses, illness, retirement
Cues similar to original trauma
Onset of neurological disorders (i.e., dementia) PTSD and Dementia
Greater risk of TBI in PTSD
PFC involvement leads to reduced emotion regulation
Cognitive decline compromises use of coping strategies
(Andrews et al., 2007) Symptoms Specific to Older Adults (Averill & Beck, 2000)
Episodic course
More intrusive memories
Greater isolation
More survivor guilt
Higer somatic complaints PTSD Treatment in Older Adults
(Cook & O'Donnell, 2005)
Exposure-based
PE, CPT
Problems with processing
Alternative approaches
EMDR
Life Review
Group interventions PTSD Considerations in Long-Term Care (Cook et al., 2001)
Full transcript