My husband was a British Army chaplain who, within six months of signing up, was posted to active duty in the Aden conflict as the British withdrew from that country with the populace at their heels. In the years that followed, he occasionally told stories of scanning rooftops for snipers whenever he left his rooms, of comforting boys terribly wounded by the equivalent of today's IED's, of writing personal letters home to their families after they died and of driving exposed through the desert to bury them, protected only by a single gunner on the back of his jeep. (Chaplains were not issued firearms.) Over time, his body succumbed to the effects of the stress and he was sent back to England with chronic pneumonia.
Despite the impact of these experiences, my husband coped quite well, from a psychological standpoint, until his mid-sixties when he developed heart failure after a viral infection. This event, with its traumatic onset, triggered the same feelings of fear and vulnerability he had felt forty years before in Aden. (And as a child in London during World War II.) As his illness progressed, so did his posttraumatic stress symptoms. In fact, during the final months of his life when he experienced increasing sleep apnea, (periods without breathing that occur during sleep), he would vividly "revisit" Aden during the breath-less periods then "return", disoriented and frightened, to the present each time he began to breathe again. This cycle would continue for hours on end, exhausting and terrorizing us both.
Fortunately, I was aware of the "new" research of the mid 1990's, research which helped us to understand and cope with these harrowing episodes. These studies of older combat veterans, holocaust survivors and Dutch resistance fighters showed that trauma survivors who were otherwise functioning well could experience a late onset or worsening of posttraumatic stress symptoms secondary to the stress of physical illness or injury, changes in environment, or medical interventions. This was what was happening to my husband and it is important information for all of us to know for a number of reasons:
1. As World War II and Korean, Vietnam, and Gulf War veterans; immigrants of war torn countries; and other trauma survivors and their families age, we will see increasing numbers of older adults in our health care, addiction and social service systems affected by late onset or exacerbation of PTS symptoms. They deserve, and will require, knowledgable and compassionate trauma-specific diagnosis and care.
2. As more of these trauma survivors enter our support systems, the possibility exists that more helping professionals, volunteers and family caregivers will experience secondary trauma exposure, creating the need for more compassion fatigue resources.
3. As both groups - helpees and helpers - age, there is also concern that cognitive impairment could keep them from identifying the sources of their symptoms and working through their trauma. This could leave numbers of survivors acting out unresolved trauma because they are no longer able to understand or express it directly.
The moral of the story for us as caregivers? As a long term care aide once said, with tears flowing down her cheeks as I finished a talk on "Trauma and Aging"-
"Listen to her. If you have trauma to heal, do it now. You never know when it's going to be too late. I see it in my patients all the time. They're in pain but I can't figure out why or what to do to help because they can't tell me what's happened to them any more."
(Caveat - This doesn't mean that we should sign up to heal our lives during the middle of a caregiving crisis. It just means that we could all do well to recognize that posttraumatic stress can worsen with age and to plan to do some appropriate therapy when the time is right - a time that is preferably sooner than later.)