Aging veterans and Combat PTSD

PTSD 101 Course
National Center for PTSD

Transcript for: Aging and PTSD
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Today we are going to talk about a topic that is near and dear to my heart, Aging and PTSD.

Hello and welcome. My name is Dr. Joan Cook and I am a psychologist on faculty in the Yale School of Medicine, Department of Psychiatry and am a researcher at the National Center for PTSD.

Veteran 1:
Our company went in with 220 men and by nightfall only 23 of us were still able to fight. We lost almost 90% that day. I got captured in September 30th of 1944, and I was a POW from the 30th of September until April the 15th of '45. And I never told anybody about my experiences, because I didn't want to remember exactly what I'd seen. What I've seen, you cannot describe! It's too horrible.

Why is the topic of aging and PTSD so important? The answer is for numerous reasons.

The number, proportion and diversity of older adults in the general population are steadily increasing, particularly in industrialized countries, where older adults are expected to constitute 33% of the population by 2050.

Compared to the scientific investigation of exposure to potentially traumatic events and potential mental health effects in other age groups, much less is known about those aged 65 and over.

The graying of the population can particularly be seen in Veterans served in the U.S. Department of Veterans Affairs (VA). In Fiscal Year 2009, almost 100,000 Veterans received services in the VA Specialized Outpatient PTSD Programs. Of these, 41% served during the Vietnam War era, 1% during the Korean War era, and 1% during the World War II era. The remainder served during other eras. So although we are losing our World War II and Korean Conflict Veterans to death, our Vietnam Veterans, which comprise a large part of our patient care in VA, are on average 59 years old and aging.

A number of my colleagues and I suspect that trauma and PTSD in older adults is under-recognized and thus under-treated. Lack of recognition of the effects of trauma including PTSD or misattribution of symptoms to other psychiatric or medical problems can have serious consequences for older adults.

Indeed it may have negative implications for older adults’ treatment and recovery, including the design of inadequate treatment plans, administration of poorly focused or inappropriate psychotherapy, medication or other medical intervention.

Veteran 2
My PTSD has changed as I've gotten older, like in my 50's, in that things have gotten more intense: my feelings, sounds, startle response. It seems like my health problems, I'm finding out now, are more related to Vietnam and the side effects of the herbicides.

And the stress, heart condition, diabetes, it just seems to pile on year after year. I find I'm getting more and more illnesses associated with my tour in Vietnam. As I've gotten older, I'm getting the nightmares more intense; waking up with the heart palpitations the sweating, you know, shortness of breath.

Veteran 3:
Well for me, when I retired, I struggled with--I had more time to think with my PTSD so, even though I was getting the treatment, I felt like I was doing well, there were episodes where, because I was getting older, I didn't feel as strong as I used to. I felt more vulnerable.

Two empirical studies present the strongest evidence to date of a link between PTSD and dementia. In one investigation, researchers followed over 181,000 Veterans over six years, including more than 53,000 with PTSD. Those with PTSD were more than twice as likely to develop dementia.

In another investigation, older Veterans with a diagnosis of PTSD, or who were Purple Heart recipients, were compared to age and gender matched Veterans with no PTSD or Purple Heart. There was a greater prevalence and incidence of dementia in older Veterans with PTSD. Those who had PTSD, but whom were not Purple Heart recipients, had almost twice the odds of developing dementia as those who did not have PTSD but were Purple Heart recipients or the comparison groups. The authors concluded that PTSD may be a greater risk factor for dementia than combat-related trauma alone.

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