Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York, USA.
Department of Psychology, University of Haifa, Haifa, Israel.
Int J Geriatr Psychiatry. 2021 Aug;36(8):1216-1222. doi: 10.1002/gps.5514. Epub 2021 Feb 26.
Failure to diagnose and treat post-traumatic stress disorder (PTSD) may help explain the substantial disability, increased cognitive decline, and adverse health outcomes suffered by older adults with this disorder. To evaluate this possibility, we examined symptom differences among older and younger individuals with PTSD and measured the frequency with which older adults receive standard of care treatment.
Clinician-Administered PTSD Scale for DSM (CAPS) scores were compared between younger and older adults with PTSD. Profiles were calculated for the most dominant CAPS symptom cluster reported by each participant, and the age cutoff best differentiating symptom clusters between individuals was determined. Clinical interview data (older adult sample only) were evaluated by trained raters to determine rates at which PTSD participants accessed treatment.
Among 108 individuals with PTSD, 69% of participants <67 years old had Criterion C (avoidance) symptoms as the most dominant cluster compared to 39% of participants ≥67 (p = 0.016). Eight percent of participants <67 years had Criterion E (hyperarousal) symptoms as the most dominant cluster compared to 30% of participants ≥67 (p = 0.016). Less than 25% of the older adults (N = 53 subsample) were receiving a first-line pharmacotherapy option for PTSD, and 0% of participants were currently participating in an evidence-based psychotherapy for PTSD.
Clinicians evaluating patients should be aware that different symptom profiles may be present between younger and older adults with PTSD. Despite their high risk for adverse neuropsychiatric and other health consequences, older adults with PTSD appear to infrequently receive first-line clinical treatment.
未能诊断和治疗创伤后应激障碍（PTSD）可能有助于解释患有这种疾病的老年人所遭受的大量残疾、认知能力下降和不良健康后果。为了评估这种可能性，我们检查了老年和年轻 PTSD 患者之间的症状差异，并测量了老年人接受标准治疗的频率。
比较了年轻和老年 PTSD 患者的 DSM 临床医师管理 PTSD 量表（CAPS）评分。为每个参与者报告的最主要 CAPS 症状群计算了概况，并确定了区分个体之间症状群的最佳年龄截止值。通过受过训练的评估者评估临床访谈数据（仅老年样本），以确定 PTSD 参与者接受治疗的比率。
在 108 名 PTSD 患者中，69%年龄<67 岁的参与者以回避症状为主导集群，而 39%年龄≥67 岁的参与者以回避症状为主导集群（p=0.016）。8%年龄<67 岁的参与者以过度警觉症状为主导集群，而 30%年龄≥67 岁的参与者以过度警觉症状为主导集群（p=0.016）。不到 25%的老年成年人（N=53 个亚组）正在接受 PTSD 的一线药物治疗选择，而没有参与者正在接受 PTSD 的循证心理治疗。
评估患者的临床医生应该意识到，年轻和老年 PTSD 患者之间可能存在不同的症状模式。尽管老年人有很高的神经精神和其他健康不良后果的风险，但他们似乎很少接受一线临床治疗。
