Older adults constitute a growing proportion of the United States population. By 2050, it is projected that adults aged 65 and older will comprise 82 million of the population – a 47% increase from 2022 (U.S. Census Bureau, 2018). In the United States, 90% of older adults have experienced a traumatic event in their lifetime (Norris, 1992). Considering the prevalence of trauma in this increasingly growing population, clinicians working with older adults must remain well-informed of the implications of trauma in aging. Roughly 2-4% of the older population meets criteria for posttraumatic stress disorder (PTSD; Acierno et al., 2007) and 7-15% exhibit clinically significant symptoms (Kaiser et al., 2025); symptoms can last more than 50 years after a traumatic event (Thorp et al., 2011). However, there is a paucity of research on older adults with PTSD.
Several developmental factors in older age can explain why symptoms of PTSD may increase in later life. These include loss, retirement, increased health problems, reduced income, cognitive impairment, decreased social support, and other stressors that may make it more difficult to cope with memories associated with trauma (Thorp et al., 2011). Individuals who once turned to avoidance-based coping strategies (such as substance use or overcommitting oneself to work) may find that these strategies are no longer available or effective.
Thorp et al. (2011) noted that the PTSD symptom of “sense of foreshortened future,” present in the Diagnostic and Statistical Manual, 4th Edition (DSM-IV), specifying that the person “does not expect to have a career, marriage, children, or a normal life span,” made little sense for older adults (and would thus make it less likely that older adults would meet the criteria for PTSD). This led to the removal of that symptom in DSM-5, along with other improvements to anxiety diagnoses for older adults recommended in the literature (Bryant et al., 2013; Mohlman et al., 2012; Thorp & Cook, 2013). In addition, by late adulthood, individuals often develop a repertoire of coping skills that contribute to adaptability and resiliency in times of adversity (Kaiser et al., 2025), and this may account for the prevalence of PTSD generally being lower in older adults compared to younger adults (Thorp et al., 2011).
Thorp et al. (2011) list a number of issues to consider when assessing older adults. That includes ensuring that all written materials (including websites and questionnaires) should be in large, bold fonts. It also includes asking about medical and psychiatric problems like vision problems, hearing problems, cognitive functioning, substance use, and history of self-injury or suicidality. Most older adults do not have cognitive impairment; however, clinicians must assess whether the patient is a poor historian or if they are forgetful or inattentive. For assessing PTSD, specifically, assessment should, of course, include a discussion of past potentially traumatic events like combat, sexual assault, and crime victimization. A mix of matter-of-fact questioning with psychoeducation about trauma can normalize any symptoms and decrease stigma. The age of onset, course, severity, and duration of PTSD should be assessed, in addition to any recent changes in health, living arrangements, employment, self-care (e.g., activities of daily living), social support, and mobility. The authors noted that many assessment measures for trauma and PTSD, such as the Clinician-Administered PTSD Scale (CAPS; Blake et al., 1995) and the self-report PTSD checklist (PCL; Weathers et al., 1993), are valid for use with older adults.
Fortunately, there are treatment options available to older adults with PTSD. Though medications are an option, few pharmacological studies focus on older adults; moreover, polypharmacy is common in the older population, and commonly prescribed medications are medications like benzodiazepines have been associated sedation, psychomotor impairment (which can increase the risk of falls), respiratory problems, and cognitive impairment (Thorp et al., 2011). Exposure therapies that encourage the repeated revisiting of traumatic memories in a therapeutic environment work well for reducing PTSD symptom severity. Prolonged exposure therapy (PE) is an efficacious psychotherapy for older military veterans (Thorp et al., 2012). Slower pacing of PE and the involvement of loved ones may enhance treatment outcomes (Thorp, 2022). Narrative exposure therapy (NET) also shows promise as a treatment for older adults, with briefer exposure than PE and potentially simpler training for clinicians (Mørkved & Thorp, 2018).
Authors: Samantha Carotenuto/Maya Webb/Eva Badillo/Steven R. Thorp, Ph.D. ABPP
Mses. Carotenuto, Webb and Badillo are graduate students and Dr. Thorp is Distinguished Professor at California School of Psychology Alliant International University, San Diego.
References
Acierno, R., Lawyer, S. R., Rheingold, A., Kilpatrick, D. G., Resnick, H. S., & Saunders, B. E. (2007). Current psychopathology in previously assaulted older adults. Journal of Interpersonal Violence, 22(2), 250–258. https://doi.org/10.1177/0886260506295369
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596 American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed, text rev.) https://doi.org/10.1176/appi.books.9780890425787
Blake, D., Weathers, F., Nagy, L., Kaloupek, D., Gusman, F., Charney, D., et al. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8, 75- 90 Cook, J. M. (2001). Post-traumatic stress disorder in older adults. PTSD Research Quarterly, 12, 1-7.
Bryant, C., Mohlman, J., Gum, A., Stanley, M., Beekman, A. T. F., Wetherell, J., Thorp, S. R., Flint, A. J., Lenze, E. J. (2013). Anxiety disorders in older adults: Looking to DSM-5 and beyond… American Journal of Geriatric Psychiatry, 21, 872-876. doi:10.1016/j.jagp.2013.01.011.
Kaiser, A. P., Wachen, J. S., Potter, C., Moye, J., & Davison, E. (2025). Posttraumatic stress symptoms among older adults: A review. PTSD: National Center for PTSD. https://www.ptsd.va.gov/professional/treat/specific/symptoms_older_adults.asp
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