Article Text

  1. S Ramaswamy1,2,
  2. A Hickert1,2,
  3. K Miller1,2,
  4. V Kolli2,
  5. D Driscoll2,
  6. Y KC2
  1. 1School of Medicine, Creighton University, Omaha, Nebraska, United States
  2. 2VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska, United States


Background and Significance Post-traumatic stress disorder (PTSD) is a chronic anxiety disorder with a lifetime prevalence of 6.8% in the general population and up to 30% among Vietnam War veterans. While presentation of PTSD is typically acute, delayed onset of PTSD (i.e., 6 months post trauma) is considered to be relatively rare. There is anecdotal evidence supporting reactivation of trauma memories and symptoms of PTSD among aging veterans who previously had no symptoms or treatment for PTSD. Clinically this type of presentation appears to be different from those presenting with symptoms earlier in life. It is unclear what might precipitate or reactivate these symptoms many years following trauma exposure. The Veterans Health Administration has a growing population of aging veterans exposed to combat during their military service. Current treatment guidelines provide limited guidance towards the management of late-onset PTSD. The prevalence of PTSD among OEF/OIF veterans is very high and as this cohort ages, we need to be better equipped to manage clinical changes seen across the lifespan. Understanding the clinical phenomenology, risk factors and potential biomarkers of this condition could pave the way for better screening methods and treatment interventions for clinicians.

Objective To identify the characteristics and risk factors among late-life post-traumatic stress disorder (PTSD) treatment seekers.

Methods The study is a retrospective chart review of patients diagnosed with PTSD after the age of 55 and a comparison group of veterans diagnosed with PTSD prior to the age of 55 in the VA Nebraska–Western Iowa Health Care System.

Results Primary variables for analysis included demographic factors, military history, age at treatment seeking, PTSD Checklist (PCL) scores, PTSD treatment, recent stressors/reasons for seeking treatment (e.g., recent life changes, another trauma or reminder), and comorbid medical conditions.

Conclusions A number of explanations have been proposed for the development of late-onset PTSD, including chronic inflammation and cumulative stress. We are conducting a separate study to determine whether plasma concentration of the inflammatory marker C-reactive protein (CRP) might help in predicting late-onset PTSD. Further studies are needed to evaluate the contributions of other factors (e.g., physical or cognitive decline, sleep disturbances, other traumas) to late-onset PTSD.

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