PTSD in late life can result from trauma that occurred much earlier or can follow traumatic events that occurred for the first time in old age. When trauma took place when the person was younger, PTSD in later life might represent the re-emergence after a period of extended quiescence or be the continuation of a chronic disorder experienced throughout adult life. DSM-5 criteria for the diagnosis of PTSD in older adults are no different from those for other age groups, with the exception of modified criteria for preschool children aged 6 years or younger.
DSM recommends using a “Delayed Expression” specifier when symptoms emerge more than 6 months after the index trauma, and the literature is replete with descriptions of older adults who experience the complete PTSD syndrome for the first time decades after the index trauma. Identifying chronic PTSD that has been present throughout most of adult life might be straightforward, although PTSD did not exist as a diagnostic entity when the older adult first developed the clinical syndrome. One Pearl Harbor survivor described his symptoms as “a non-stop movie playing in my head” that began soon after the attack. Decades later he received a diagnosis of PTSD and was subsequently treated with medications and psychotherapy.
Identification and treatment of PTSD in later life can present multiple challenges, starting with the unique aspects of the symptomatology of the disorder in older adults and from the issues with their treatment-seeking. For example, older adults might report somatic presentations over emotional-psychological symptoms. A higher intensity of hyperarousal symptoms, especially if the trauma occurred later in life, are reported while intrusive re-experiencing symptoms are not mentioned. Cognitive impairment and dementia—the risk of which is increased from a lifetime diagnosis of PTSD—might also interfere with the older adult’s ability to interpret and communicate symptoms.