Many Older Veterans Suffer PTSD in Silence

Katharine Gammon

April 02, 2013

LOS ANGELES — Veterans may continue to suffer with posttraumatic stress disorder (PTSD) long into their golden years, a new study shows.

Investigators at the Armed Forces Retirement Home in Washington, DC, found that among a cohort of older veterans, 17% endorsed symptoms of PTSD, and about 30% had traumatic brain injury (TBI).

"It looks like the prevalence of PTSD and TBI for veterans from Vietnam and other conflicts is the same as for those returning from newer wars, and we have a lot to learn by looking at resiliency and long-term consequences for these older vets. There is growing concern that PTSD may increase the risk of dementia later in life," Windsong Hollis, MD, a geriatric psychiatrist with the Armed Forces Retirement Home, told Medscape Medical News.

The study was presented here at the American Association for Geriatric Psychiatry (AAGP) 2013 Annual Meeting.

To determine the prevalence of PTSD, a self-administered survey was sent to 400 volunteers living independently at the Armed Forces Retirement Home to assess prevalence of TBI, combat experience, PTSD symptoms, and memory complaints.

A total of 87 surveys were returned; 72 (86%) respondents completed the PTSD Checklist–Civilian Version (PCL-C). Although only 4% of participants declared a diagnosis of PTSD, the prevalence of active PTSD was much higher, with 12 of the veterans (17%) scoring 30 or higher on the PCL-C.

Well more than half (67%) of respondents reported having a lifetime emotional health problem; such problems included depression, attention-deficit disorder, anger issues, mania, anxiety, and substance abuse.

Dr. Hollis said that the stigma of reporting PTSD may have prevented some of the veterans from seeking treatment for many years.

"There are good treatments available, like blood pressure pills and exposure therapy, but the problem is some veterans are not seeking it out, even though they need it," she said.

The investigators are planning a detailed cohort study to examine these veterans more closely.

Hiding the Disorder

Commenting on the study for Medscape Medical News, Steven R. Thorp, PhD, University of California, San Diego, and program director, PTSD Clinical Team Veterans Affairs (VA) San Diego Healthcare System, applauded the investigators' efforts to take on such a complex research project.

"This study was designed as a pilot study to inform a larger trial, and thus it was not sufficiently powered to detect population-based prevalence rates. Rather, it suggests that for a small, specific sample of veterans who reside in the Armed Forces Retirement Home, a significant number report current PTSD and histories of head injuries," said Dr. Thorp, who was not involved in the research.

Because only 72 of 400 invited residents completed the PCL, Dr. Thorp noted that those veterans who participated may be different from those who did not.

Older-generation veterans may be misdiagnosed because their symptoms look different from those of younger vets with PTSD, Paula Schnurr, PhD, deputy executive director of the VA National Center for PTSD, in Washington, DC, told Medscape Medical News.

"Older veterans seemed to look a bit more functional on the outside — they kept marriages, kept jobs, and suffered a bit more in silence. In essence, older veterans tended to keep disorder more hidden. It's my speculation that problems went unrecognized because we didn't have labels, these veterans didn't look like they had the same degree of problems," she said.

Dr. Hollis, Dr. Thorp, and Dr. Schnurr report no relevant financial relationships.

American Association for Geriatric Psychiatry (AAGP) 2013 Annual Meeting. Abstract NR 38. Presented March 15, 2013.