Research indicates that traumatic experiences impact the mental health of older adults. Clinicians should consider the effect of intergenerational trauma on the mental health of older adults as well as the effect of directly experienced trauma.
How Common is Trauma Exposure Among Older Adults?
The Nurses’ Health Study II found that more than 80% of women ages 53–74 experienced at least one traumatic event in their lifetime. And 10.5% of those women met the criteria for lifetime PTSD.
Other studies have found that among older adults the prevalence of trauma exposure was greater among men, perhaps as a result of more men experiencing active military service in the armed forces.
What Is Intergenerational Trauma?
Intergenerational trauma refers to the transmission of trauma experiences and their psychological and physical effects across generations. When individuals experience traumatic events such as war, genocide, natural disasters or systemic oppression, the impact can extend beyond their own lifetimes and affect their descendants in long-lasting and sometimes unexpected ways.
Cumulative Effects of Trauma (Direct and Intergenerational)
Cumulative exposure to traumatic events contributes to higher levels of post-traumatic stress in older adults. These exposures can include exposure to violence in childhood or adulthood, other forms of trauma and intergenerational trauma.
Substantial research has demonstrated a dose-response relationship between exposure to traumatic events and the development of PTSD symptoms. A dose-response relationship for PTSD describes a relationship between exposures and post-traumatic stress disorder symptoms. “Dose” can be measured in the number of traumatizing experiences, the duration of traumatic events and the intensity of the experiences.
This dose-response relationship holds for older adults as well as for younger cohorts. The effects of intergenerational trauma should be considered when evaluating the possible impact of trauma on the mental health of older adults.
The lifetime effect of trauma, including the intergenerational transmission of trauma, traumatic events in childhood and traumatic experiences during adulthood can combine and manifest as the symptoms of PTSD.
Can the Effects of Trauma Appear Late in Life?
In general, it does not seem that an individual would be completely asymptomatic and then suddenly manifest symptoms as an older adult related to intergenerational trauma or traumatic events that occurred in the distant past.
A more likely scenario is that people are often able to successfully practice avoidance as they are building a career or raising a family. It does not mean that the symptoms totally disappeared, but the individual may have been successful in avoiding significant stress. At retirement, however, the individual has more time to ruminate and fewer distractions to keep difficult memories at bay. Symptoms that just weren’t expressed before retirement can come to the fore after retirement.
Psychological stresses at an older age can contribute to bringing symptoms to the surface. The death of a spouse, grief over the loss of meaning that can accompany retirement, shrinkage of friend and family networks, physical limitations and other stressors can make it more difficult to manage symptoms that may have been on a low flame during an earlier period of life.
PTSD, Dementia, and Delayed-onset PTSD
PTSD appears to be a significant risk factor for developing dementia, and advanced age is associated with delayed-onset PTSD. Some research suggests that older adult combat veterans may be particularly vulnerable to delayed-onset PTSD. It is likely that the processes are intertwined. PTSD increases the risk for dementia, and dementia, in turn, increases the risk for delayed-onset PTSD.
The symptoms of dementia can overlap with post-traumatic stress symptoms. Hyperarousal, anger, and other symptoms can result from PTSD or dementia. For older adults, especially older adults with cognitive impairments, it can be easy to assume (mistakenly, in cases where PTSD is a factor) that the symptoms are purely dementia-related.
Shouldn’t Age Diminish the Effect of Intergenerational Transmission of Trauma and Other Traumatic Events?
It would be a mistake to assume that a disorder that erases memories and reduces capacity for self-reflection will also diminish the power of traumatic memories. The triggers associated with PTSD are largely unconscious. When the brain responds to a trigger, it responds as if the traumatic event is taking place in the present.
An older person in a memory care facility may respond to food as though famine was present in their lives today (even though it may be an intergenerational transmission of the memory of famine) or to being gently restrained as though they are being assaulted in the present (even though they are reacting to a memory of a parent or grandparent being imprisoned or deported). Social and cognitive impairments can make it more difficult for the older person to manage those intense feelings.
Recommendations for Professionals Treat Elders
Standard practice should include assessment for trauma history, including intergenerational trauma, and PTSD symptoms. Psychotherapies for late-life PTSD seem to be efficacious with cognitively intact older adults (although there is a dearth of randomized control studies).
Staff working directly with patients should be made aware that symptoms of depression (mood changes, diminution of cognition, loss of interest in activities, blaming others, detachment) may be the result of unresolved trauma.
Staff should work to cultivate a safe, supportive environment where patients can open up about traumatic experiences, or the traumatic experiences of their parents. By helping patients talk about trauma, professionals can better identify and address PTSD when it is present. Identification of PTSD in older adults is a key step to providing effective treatment for PTSD.
Dr. Fabiana Franco, PhD, DAAETS, FAAETS, is a clinical psychologist in New York City and former clinical professor of Psychology at The George Washington University. She is a founding member and president of the Trauma Special Interest Group of the New York State Psychological Association and co-chair of the Intergenerational Transmission of Trauma and Resilience Group at the International Society for Traumatic Stress Studies. Dr. Franco holds a Level II Certification in Complex Trauma from the International Association of Trauma Professionals and Fellowship and Diplomate Credentials with the American Academy of Experts in Traumatic Stress and the National Center for Crisis Management.
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