Traumas Experienced by Elderly
By: James J. Messina, Ph.D., NCC, CCMHC, DMHS-T
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What is Trauma?
Individual trauma is a result of an event, series of events, or set of circumstances that can be sudden or drawn out, which present physical or emotional harm to an individual, or are life threatening. Traumatic events may have lasting adverse effects on an individual’s functioning and mental, physical, social, emotional, and spiritual wellbeing (SAMSHA, 2014).
Up to 90% of older adults have experienced at least one traumatic event in their lifetime (Pietrzak, et.al, 2012). Approximately 70% to 90% of adults aged 65 and up have been exposed to at least one potentially traumatic event during their lifetime (National Center of PTSD, 2017).
Symptoms of trauma can evolve after long symptom-free periods’ Reemergence of trauma symptoms after symptom-free periods is not uncommon. Symptoms of trauma can emerge for the first time during older adulthood-decades after exposure to traumatic events. Symptoms of trauma emerging in older adulthood can be more extreme that previously experienced (CAT, 2023).
Significant life changes which can rekindle experience of trauma from earlier times in the life of elderly are: Change in Family Roles; Beginning of Retirement; Emergence of Health Problems; Loss of Independence; and Loss of Loved Ones (CAT, 2023)
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Symptoms of Trauma:
Older adults who experienced trauma later in life report more avoidance, sleep problems, and hyperarousal than younger adults (Kaiser, et al., 2022)
Other common symptoms of the impact of trauma on aging adults are:
- Noticeable changes in mood, energy level, or appetite
- Feeling flat or having trouble feeling positive emotions
- Difficulty sleeping or sleeping too much
- Difficulty concentrating, feeling restless, or on edge
- Increased worry or feeling stressed
- Anger, irritability, or aggressiveness
- Ongoing headaches, digestive issues, or pain
- Misuse of alcohol or drugs
- Sadness or hopelessness
- Thoughts of death or suicide or suicide attempts
- Engaging in high-risk activities
- Obsessive thinking or compulsive behavior
- Thoughts or behaviors that interfere with work, family, or social life
- Engaging in thinking or behavior that is concerning to others
- Seeing, hearing, and feeling things that other people do not see, hear, or feel (NIMH, 2023).
Some of the common symptoms of psychological trauma include:
- Fear, ranging to overwhelming fear.
- Obsessive and compulsive behaviors.
- Detachment from other people and emotions.
- Emotional numbing.
- Changes in libido/interest in sex.
- Depression.
- Guilt, survivor guilt.
- Shame, self-blame (Rose Hill Center, 2023)
Behavioral Signs of Unhealed Trauma: Trauma can also lead to elderly experiencing behavioral idiosyncrasies. For instance, they may avoid places or activities that make them think about the event. They may withdraw from their friendships and become uninterested in the activities that they enjoyed in the past. In addition, they may begin practicing obsessive behaviors, such as compulsively checking locks on their doors (Rose Hill Center, 2023).
Physical Signs of Unhealed Trauma: Elderly that have experienced a traumatic event may be startled easily, which can cause heart problems and edginess. They may also be extremely alert because they are constantly looking for the next potential danger. Furthermore, they may be unable to sleep through the night, leading to excessive fatigue or feeling exhausted (Rose Hill Center, 2023).
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What are other issues that seniors would perceive as trauma?
They are:
- Loss of spouse and peers
- Chronic and life-threatening diagnoses
- Accidents, falls
- Physiological changes, limitations, disability
- Loss of roles and resources
- Increased dependence on caregivers
- Cognitive or memory loss
- Loss of home
- Abuse
- Neglect
- War, or terrorism
- Domestic violence
- Historical trauma
- Death by suicide
- Disaster
- Community violence
- Exploitation
- Attachment disruption or abandonment as a child (NIMH, 2023).
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Falls a major type of Trauma Experienced by the Elderly: Falls are the main cause of trauma in the elderly, accounting for 75% of cases, and are often low-level from standing or sitting height (Atinga, et al, 2018). These may be mechanical or due to a variety of medical causes. Injuries due to such low-level falls in the elderly should not be presumed to be insignificant and can carry serious consequences. Falls are the fifth leading cause of death in adults over 65 years old (Atinga, et al., 2018).
Approximately 30% of individuals over the age of 65 living in the community (and > 50% of those living in residential care settings) fall every year. Furthermore, half of these do so repeatedly. Although these falls are diverse in their risk factors, precipitants, and mechanics, 20% of falls result in injury requiring medical attention (5% result in fractures or other serious injury). Among women over the age of 75, these percentages double. Despite the importance of the foregoing etiologies of trauma, more than 80% of all injury-related admissions for those over the age of 65 years are due to falls. Furthermore, these all too often are sentinel events. Perhaps the most feared consequence of a fall—a hip fracture—in addition to commonly being associated with long-term pain and functional impairment (< 50% fully recover), is associated with a 20% chance of death and a 25% chance of institutionalization as a direct result. Falls (especially with injury) are usually the result and cause of gait and balance difficulty. As one fall increases the risk of future falls, and fear of this leads to decreased mobility, gait and balance further deteriorate in a vicious, isolating cycle.
Falls may be thought of as resulting from the interaction of intrinsic (specific to the individual) and extrinsic (environmental) risk factors triggered by a precipitating cause. Examples of the former include arthritis, visual impairment, vestibular dysfunction, neuropathy or muscle weakness, as well as gait and balance problems that may result from improper footwear, restraints, or other environmental hazards. These factors dramatically increase the chance of a fall when coupled with acute or exacerbations of chronic illness, slips/trips, dizziness, or syncope (Blumenthal et al., 2010).
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Impact of ACE Factors on Elderly:
A recent research study found that individuals who experienced violence during childhood or Adverse Childhood Experiences (ACE factors) were 40% more likely to have mobility impairments and 80% more likely to struggle with daily activities. Similarly, those from unhappy families had a 40% higher chance of mild cognitive impairment later in life. The research highlights the long-lasting ramifications of early life stressful experiences, affecting people even in their 60s, 70s, 80s, and beyond (Open Access Government, 2023).
Nearly 60% of adults in the U.S. have encountered adverse childhood experiences, including violence, illness, financial stress, and separation from parents, which can negatively impact their sense of safety and stability.
The Centers for Disease Control and Prevention (CDC) links ACEs to chronic physical and mental health conditions, such as cardiovascular disease, diabetes, autoimmune disease, and depression (Open Access Government, 2023).
Surviving abuse or trauma as a child has been linked with higher rates of anxiety, depression, suicide and self-harm, PTSD, drug and alcohol misuse and relationship difficulties (ISTSS, 2023).
Traumas and adversities in childhood may leave scars that last into adulthood and put a person at risk for a variety of difficulties. This is true for all kinds of early traumas including accidents, disasters and witnessing violence directed at others, but it is especially true for child abuse and neglect, the victims of which have been studied extensively. Not all childhood trauma survivors experience difficulties in adulthood. However, for many people, it may be important to come to terms with past traumatic events. People who have been in treatment can gain relief from anxiety and depression and are able to stop focusing on the disturbing memories and feelings associated with traumatic childhood events (ISTSS, 2023).
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References
Atinga A, Shekkeris A, Fertleman M, Batrick N, Kashef E, & Dick E. (2018). Trauma in the elderly patient. British Journal of Radiology, 91(1087):20170739. doi: 10.1259/bjr.20170739
Blumenthal, J., Plummer, E., & Gambert, S.R. (2010). Trauma in elderly: Causes and prevention. Consultant 360 Multidisciplinary Medical Information Network, 18(01). Retrieved at: https://www.consultant360.com/articles/trauma-elderly-causes-and-prevention
Center on Aging and Trauma (2023). Aging and trauma fact sheet. Retrieved at https://cdn.fedweb.org/fed-42/2/AgingAndTrauma_FactSheet_CenterOnAgingAndTrauma_2fdbr.pdf
International Society for Traumatic Stress Studies (ISTSS) (2023). Effects of childhood trauma on adults. Retrieved at: https://istss.org/public-resources/trauma-basics/what-is-childhood-trauma/effects-of-childhood-trauma#:~:text=Surviving%20abuse%20or%20trauma%20as,alcohol%20misuse%20and%20relationship%20difficulties.
Kaiser, A.P., Wachen, S.S. Potter, C., Moye, J. & Davison, E. (2022) Posttraumatic stress symptoms among older adults: A review. Retrieved at: https://www.ptsd.va.gov/professional/treat/specific/symptoms_older_adults.asp
National Institute of Health (2023). Older adults and mental health. Retrieved at: https://www.nimh.nih.gov/health/topics/older-adults-and-mental-health
Open Access Government (2023). Trauma in youth linked to poor health in old age. Retrieved at: https://www.openaccessgovernment.org/trauma-youth-poor-health-in-old-age/164691/#:~:text=Impact%20of%20childhood%20trauma,cognitive%20impairment%20later%20in%20life.
Pietrzak, R. H., Goldstein, R. B., Southwick, S. M., & Grant, B. F. (2012). Psychiatric comorbidity of full and partial posttraumatic stress disorder among older adults in the United States: Results from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. The American Journal of Geriatric Psychiatry, 20(5), 380390. doi:10.1097/JGP.0b013e31820d92e7
Rose Hill Center (2023). Signs you may need trauma therapy. Retrieved at: https://www.rosehillcenter.org/mental-health-blog/signs-you-need-trauma-therapy/#:~:text=Physical%20Signs%20of%20Unhealed%20Trauma,for%20the%20next%20potential%20da
Substance Abuse and Mental Health Services Administration (2014) SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf
Texas Health and Human Services (2017). Trauma informed care and the aging population. Retrieved at: https://www.hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/resources/trauma-inform-care-holocaust-survivor.pdf
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