Posttraumatic Stress Disorder and Aging.

Posttraumatic Stress Disorder (PTSD) is not typically viewed as a prototypic mental health concern in the context of geriatric mental health; however, it is profoundly important for clinicians and researchers in geriatric psychiatry to attend to this condition. In part, there is the demographic imperative, the “graying of America,” that applies across many if not most psychiatric conditions as the first of the BabyBoom generation (notably, the generation most directly subject to the draft during the Vietnam War) began turning 65 in 2010. Given the high rates of PTSD among military combat veterans it is notable that in 2014 there were already an estimated 9.4 million veterans age 65 or older, including 4.5 million over age 75. In addition, future generations will see a second wave of combat-related PTSD from veterans involved in the wars in Afghanistan and Iraq. Indeed, a recent meta-analysis suggested a prevalence of PTSD among Afghanistan/Iraq veterans of up to 23%. In addition, as noted by Smith et al. (this volume), for a complex array of reasons these recent conflicts have resulted in an increase in newly diagnosed PTSD among Vietnamera veterans. In addition, there is the much less studied issue of PTSD from non-military related traumas among older adults. Estimates of lifetime prevalence of PTSD in the general community have varied widely across studies, but appear to be between 3.6%–6.3% among men and 7.9% and 13.8% among women. The above statistics suggest we are beginning a period of increased prevalence of PTSD among older adults. This trend is likely to continue even beyond the demographic influence of the Baby-Boom generation on the population parameters particularly as the OEF/ OIF/OND veterans and their civilian peers with PTSD continue to age. Moreover, the issue of aging and PTSD is not limited to a future concern when people reach 65 or some other cut-off defining “older age.” As documented in the comprehensive review by Lohr et al. recently published in this journal, there is strong evidence that PTSD is associated with an accelerated or premature aging process. For example, Lohr et al.’s review indicated PTSD is associated with significantly increased risk of mortality (pooled hazard ratio weighted by sample size was 1.29 indicating a 29% increased risk of mortality for those with PTSD). Lohr et al.’s review also indicated an association of PTSD with increased prevalence of several age-related medical conditions, including heart/cardiovascular disease, new onset metabolic syndrome or type 2 diabetes mellitus, and gastrointestinal ulcers. There was also a consistent finding of increased risk of dementia among those with PTSD, which parallels findings from an earlier meta-analysis showing increased risk of neurocognitive deficits among those with PTSD. In short, the issue of PTSD and aging has considerable public health and humanitarian significance. Yet there is a clear need for further research to better document the prevalence, long-term outcomes, and mechanisms of interaction of PTSD and aging, as well as to guide age-appropriate interventions. This information is critical for both researchers and clinicians (both mental health professionals and general physicians) to better guide treatment of older adults with PTSD, as well as to help prevent premature aging among those with PTSD across the life-span. The present volume of American Journal of Geriatric