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Trauma In Older Adults

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Traumatic injury is a major contributor to total global burden of disease, and has a serious impact on health and quality of life. Each year in the US, approximately 2.5 million individuals incur injuries so severe that they require acute care hospital admissions (Bonnie et al., 1999). Richmond et al. (2002) found that 90% of a sample of seriously injured older adults survived, which indicates that outcomes beyond survival—such as acute stress reactions and the potential to develop PTSD must be evaluated and addressed for this patient population in the clinical setting. Adults who sustain serious injuries may experience acute stress reactions immediately following the event, and during and after inpatient hospitalization, and …show more content…

Zatzick et al., (2008) found that more than 20% of injured trauma survivors across the US develop symptoms consistent with a PTSD diagnosis 12 months after acute care in-patient hospitalization. Consensus guidelines from the National Institute of Mental Health identified seriously injured trauma survivors as a group at high risk for development of PTSD and related comorbid conditions (National Institute of Mental Health, 2002). In addition to the potential of the actual injury to cause traumatic stress, trauma patients may already have other risk factors for PTSD including low socioeconomic status, presence of mental illness, history of combat exposure, childhood neglect or abuse, sexual assault, or previous trauma (Shalev et al., 1994; Brewin et al., 2000). The experience of post-injury hospitalization has also been identified as a potential risk factor for development of PTSD. Several studies found that acute care patients requiring intensive care unit (ICU) admission, intubation, and mechanical ventilation are at risk for development of PTSD (Shaw et al. 2004; Cuthbertson et al., 2004; Kapfhammer et al. 2004; …show more content…

These adaptive mechanisms can become maladaptive if unresolved after precipitating events have passed, leading to interferences in emotional regulation (Liston, McEwen, & Casey, 2009; Juster et al., 2011). Imaging studies show alterations in the brain structures that assist in regulation of the stress response—the amygdala, hippocampus, and prefrontal cortex—due to prolonged exposure to stress (Carrion et al. 2010; Rao et al. 2010). The over activation of this fear circuitry in the brain can lead to distorted processing, contributing to depression (Thienkrua et al., 2006; Neria, Besser, Kiper, & Westphal, 2010; Rao et al., 2010), anxiety (Derryberry and Reed, 2002; Goldin et al., 2009; Graham and Milad, 2014), and mood impairments (Kobasa, 1979; Linehan, 1993; Haller and Miles, 2004). These cognitive changes can also contribute to insomnia, chronic pain, addictive disorders, impairment of immunity, and development of coping mechanisms such as smoking, use of alcohol or drugs, overeating, and other survival mechanisms (Raja, 2012). The allostatic load of a chronically over-activated hypothalamus-pituitary-adrenal system can lead to development of comorbid health conditions such as cardiovascular disease,

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