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We discuss psychological trauma, notably Posttraumatic Stress Disorder (PTSD), at late life, paying special attention to what is distinctive at advanced ages. PTSD is fundamentally a diathesis-stress disorder. The role of aging as a mediating or moderating influence in the expression of psychological trauma is highlighted, especially as it applies to the oldest old. As a general position, older victims tend to be no more or less vulnerable or reactive to trauma than younger victims despite increasing stress rates at older ages. That said, older age presents differences in both the experience of life and in the integration of trauma into one's life narrative. In examining aging as it relates to trauma, we first discuss the biological sequelae of trauma in PTSD, as well as the effects of a biological core feature of aging: memory impairment and overall cognitive decline. PTSD is then considered as it relates to the understanding of the self in aging. Later, we elaborate on relevant PTSD models, especially the Developmental Adaptation and Changes of Adaptation models. We end with an examination of PTSD interventions originally developed for younger age groups and review the empirical support for older adults.
This chapter discusses problems with psychosocial treatments for the oldest old. We attempt to straddle the tenets of the Developmental Adaptation and Changes of Adaptation models as well as the offerings in other chapters. We highlight how the distal and proximate variables noted in the previous chapters are necessary but not sufficient for the eventual understanding of treatment outcomes in the oldest old. To date, the psychosocial adjustment and treatment of the oldest old have been largely ignored, having been given short shrift as a result of the medical model. The present chapter considers the biopsychosocial model as it applies to this developmental stage – issues, problems, strengths, and future directions. Given inherent biological limits, we specify the role of a life lived, one's life history, and how this might influence current stress and well-being. Finally, we discuss treatment models for other age groups and their applicability to empirically supported principles for oldest-old adults.
In our chapter on posttraumatic stress disorder (PTSD), we argued that the trauma response is fundamentally a diathesis-stress response. The role of aging as a largely moderating influence in the expression of psychological trauma was construed as somewhat distinct, especially for the oldest old. Trauma itself is multidimensional and mixes with age, a variable that owns both positive and negative features as it relates to health and well-being. In that chapter, treatment required a focus on the “person” of the victim of trauma.
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