Survivors. A review of the late-life effects of prior psychological trauma.

The author reviews the literature on the epidemiology, symptom picture, and treatment of elderly patients who have encountered serious psychological trauma earlier in life. Data are predominantly derived from studies of aging Holocaust survivors and combat veterans from World War II, the Korean Conflict, and Vietnam, Survivor syndromes persist into old age, but patterns of expression vary. Holocaust survivors appear to have adapted well to instrumental aspects of life, whereas combat warriors may show less functional life-adaptation. Persisting symptoms in all groups include marked disruptions of sleep and dreaming, intrusive memories, impairment of trust, avoidance of stressors, and heightened vulnerability to various types of age-associated retraumatization. There is a deficiency of controlled treatment studies of traumatized elderly patients, but successful group, individual, and family clinical interventions have been described.