“Bill’s gone!” a choked and weeping voice shouted when I recently answered the phone.
I couldn’t believe it. Bill was larger than life! How could the world exist without him in it? We had been best friends since the first grade. How do I respond to such a life-changing event? Or consider how others in our community respond when informed about their debilitating illness or a devastating diagnosis to explain their chronic pain.
Such traumatic losses are too familiar, especially with seniors. Trauma can be described as an emotional response to a terrible event that can lead to distress and difficulty in functioning. Despite all the research, trauma’s impact is not fully understood by many, and its effects on us are severely underestimated, especially among seniors. Terms such as Post Traumatic Stress Disorder attempt to clarify trauma’s effects. The term Post Traumatic Stress Disorder emanated from research on Vietnam veterans leading to a formal diagnosis in 1980 and included women and men suffering from sexual assault and rape.
But how does trauma affect older adults?
The problem with the PTSD diagnosis is that it doesn’t account for the impact of continuous trauma or fully explain the delayed onset of symptoms that will likely affect seniors predominately. Trauma can be complex and can range from mild to extreme. It can be the result of a single episode or from repeated episodes over an extended period of time. Trauma can be experienced following the triggering event itself or its symptoms can emerge later in life.
Older adults can be subject at a greater rate than younger age groups to complex trauma, such as losing loved ones, losing bodily function or being subject to a disease process. What is the cumulative effect on older persons that have suffered from lifelong complicated trauma? Despite our specific age-related vulnerabilities, there appears to be less research emphasis on the impact of trauma on older adults. Many seniors suffering from various forms of trauma have significant trouble managing their cognitive, sensory or functional impairments. As the aging population is increasing steadily with time, experienced trauma by the elderly will likely increase in frequency and severity.
According to the National Institute of Mental Health, 72% of women 70 or older are experiencing a form of “interpersonal trauma.” Many women have and may continue to suffer from the effects of early abuse, sexual assault and/or domestic violence. Veterans without a reported history of PTSD may experience delayed onset of symptoms as they age. According to the Veterans Administration officials, 70% of male vets and 40% of women vets have been exposed to trauma in their lifetimes.
As we age, we have fewer social/family ties to address our health, living arrangements, finances, socialization and nutritional needs. The experience of trauma in the elderly is, I believe, more commonplace than previously believed. What does the experience of early abuse or neglect look like in the absence of effective trauma-informed treatment as one gets older? What happens to someone who has not come to terms with a traumatic past? They certainly do not feel safe in their world.
Those who have recovered have re-established their place in the world, and have likely re-experienced a felt sense of security, safety and inclusion. How does character formation factor into one’s response to traumatic experiences? Why do some appear to succumb to the effects of trauma while others do not? Do the effects of extreme forms of trauma cause or contribute to the terrible things that people do? For those seniors who have been traumatized, can they be a force for good in the world?
According to Bessel Van der Kolk, extreme trauma reorganizes how our body and mind perceive threats while feeling insecure and unsafe. In this state, one operates as if the trauma is still going on. Every new encounter is adversely affected by one’s unresolved traumatic past. Bessel Van der Kolk and other experts state that for change to take place the body must learn and know that the danger has passed. Our brain and nervous system are no longer organized to expect something terrible to happen. The world is no longer seen as a threatening place. Bessel Van der Kolk’s book “The Body Knows the Score” is brilliant and a very popular book about trauma. Yet there is little in the book that addresses trauma in the elderly population.
Another theory on trauma developed by Stephen Porges Ph.D is called Polyvagal Theory. It references the Vagus nerve and its connections with the brain, stomach, heart, lungs and intestines. The theory is an attempt to understand the biology of safety, vulnerability and danger. The theory goes beyond “fight or flight” and into the social relationships that underlie our experience of trauma. This theory addresses the life span but does not appear to address fully the specific effects of trauma on the elderly.
Peter Levine, a trauma expert, created a body-based therapy that explores the “imprints” of past trauma on current functioning. Patients are given tools that can heal the negative effects of physical sensations while allowing the past trauma’s impact to subside, taking into account the perception of personal safety and stability, and the release of emotions trapped in one’s physical body. As powerful as this treatment is, there is no apparent attempt to address the unique needs of traumatized seniors.
Many physical and mental health assessments do not include evaluating trauma and its effects on physical or mental health functioning. Seniors as a group do not see their symptoms or current conditions from a mental health perspective. Aging successfully requires a realization that the effects of trauma can be an impediment to our growth and development. The powerful impact that trauma has on the lives of seniors should no longer be dismissed. As seniors, the life challenges that we face are unique and so we deserve equal time with other age groups in the investigation of what role trauma’s effects play in our lives.
Editor’s Note: We’d like to invite our readers to submit their civil comments, pro or con, on this issue. Email AZOpinions@iniusa.org.
