Surgery Risk Factor for PTSD in Older Adults
New findings from a team of German researchers identify the use of general anesthesia during surgery as a PTSD risk factor for older adults, especially in individuals who develop a condition called postoperative delirium.
Doctors diagnose post-traumatic stress disorder (PTSD) in people who experience seriously negative mental health consequences of exposure to highly dangerous or life-threatening circumstances at least one month after such exposure occurred. In a study published in March 2015 in the European Journal of Anaesthesiology, researchers from several German institutions sought to determine how often older adults develop PTSD after receiving general anesthesia during surgery. In addition, these researchers sought to identify the underlying risk factors for the onset of PTSD in older adults who receive general anesthesia during surgery.
Older Adults and PTSD
Roughly 1.5 percent to 4 percent of all U.S. adults over the age of 60 have diagnosable symptoms of post-traumatic stress disorder, the U.S. Department of Veterans Affairs’ National Center for PTSD reports. However, since researchers know relatively little about the frequency of the disorder in older populations, the rate of diagnosable PTSD in older Americans may be substantially higher. In addition, a relatively large number of people over the age of 60 (7 percent to 15 percent) have some indications of post-traumatic stress disorder, but not enough to merit an official diagnosis.
A number of known factors may make older adults more susceptible to PTSD, which is usually linked to exposure to sources of trauma such as sexual assault, physical assault, combat, natural disasters and major accidents. Chief among these age-specific factors is an increasing likelihood of experiencing changes in mental and physical function that make it harder to cope with traumatic circumstances encountered earlier in life. Common examples of such changes include impaired higher-level thought processes and diminishing sharpness of one or more of the five senses. Other factors that can increase older adults’ susceptibility to PTSD include age-related loss of employment, diminished financial resources, the death of spouses or other loved ones and reduction of the size of social support networks.
Older Adults and Postoperative Delirium
Doctors and researchers use the term postoperative delirium to describe a severely confused mental state that arises in the aftermath of an anesthesia-based surgical procedure. This confused state is recognized as the most likely surgical complication in all adults age 65 or older; depending on the source in use, estimates of the rate of postoperative delirium in older adults who undergo surgery range from a low of 5 percent to a high of 50 percent. Problems associated with postsurgical delirium in the elderly include a greater chance of developing other surgical complications, longer hospital stays, potentially permanent declines in higher-level mental skills, a potentially permanent loss of daily independent living skills and increased chances of dying.
Surgery, Postoperative Delirium and PTSD
In the study published in the European Journal of Anaesthesiology, researchers from German institutions, including Charite Medical University of Berlin, Naestved Hospital and Max Planck Gesellschaft, used a project involving 559 people to estimate the frequency of PTSD in older adults who receive general anesthesia during surgery. The researchers used the same project to explore the reasons why exposure to anesthesia-based surgery contributes to older adults’ PTSD risks. All of the study participants were 60 or older and had received general anesthesia for a non-heart-related surgical procedure. None of the participants had a history of mental impairment prior to undergoing surgery. Three months after their procedures, all of the study participants took a screening tool, called the Post-Traumatic Stress Syndrome 14-Questions Inventory Score or PTSS-14, designed to detect the presence of diagnosable PTSD.
The researchers concluded that 12 percent of the older adults enrolled in the study had diagnosable PTSD symptoms three months after receiving general anesthesia during surgery. They also concluded that 14 percent of the participants developed postoperative delirium in the aftermath of their surgical procedures. After reviewing a range of risk factors (including patient age, gender, length of exposure to anesthesia, level of pain after surgery and PTSS-14 scores one week after surgery), the researchers concluded that postoperative delirium is the only clear source of increased PTSD risk in older adults who undergo surgery. Conversely (and perhaps curiously), the researchers found that older adults affected by depression at the time of their surgeries have reduced chances of developing postsurgical PTSD.