Post-traumatic stress disorder (PTSD) symptoms in later life

Objectives: Around three in four older adults report exposure to at least one traumatic event, however, only a small proportion develop PTSD. Making a PTSD diagnosis in later life can be challenging for a number of reasons, including underreporting of trauma history and misattribution of symptoms to a physical illness. Research on PTSD in older adults remains scarce and little is known about complex factors involved in the experiences of PTSD. The primary objective of this thesis was to investigate factors relevant to the development and maintenance of PTSD in later life. A systematic review was conducted with the aim of summarising and critically appraising literature on the relationship between delirium, a hypothesised risk factor for PTSD, and subsequent PTSD symptoms in older hospital inpatients. The systematic review also explored the relationship between age and PTSD following hospital discharge. An empirical study was designed to examine the predictive utility of emotion regulation strategies, cumulative trauma exposure, group identifications and socioeconomic deprivation on current PTSD symptoms in older adults. These factors were hypothesised to influence the experience of PTSD in later life based on findings from younger adult populations. Method: A systematic search strategy across five electronic databases identified eight studies which met the eligibility criteria. A cross-sectional study recruited an opportunistic sample of 88 older adults in receipt of psychological treatment for common mental health disorders. Study participants provided basic demographic information and completed self-report measures of traumatic events, emotion regulation difficulties, PTSD symptoms and group identifications. Socioeconomic deprivation was determined with the Scottish Index of Multiple Deprivation (SIMD). Results: Five of the eight studies included in the systematic review found that delirium was associated with PTSD symptoms, either at follow-up or during hospital stay. Three of the eight studies additionally investigated the relationship between age and PTSD symptoms in patients with and without delirium. Two of the three studies found that older age was associated with less PTSD symptoms after hospital discharge. The empirical study found that limited access to emotion regulation strategies and cumulative trauma exposure significantly contributed to PTSD symptoms in older adults, explaining a high proportion of variance (58%) in PTSD scores. Contrary to expectations, group identifications and socioeconomic deprivation did not add further predictive value to the model. Conclusion: The systematic review suggested that the prevalence of PTSD after hospital discharge is higher than in general population and appears to be associated with in-hospital delirium. Older age was indicated as a protective factor for PTSD following a hospital stay. However, the available literature is considerably heterogenous, with a small number of studies and significant limitations. Findings from the empirical paper suggest that limited access to emotion regulation strategies may be a vulnerability factor in the development and maintenance of PTSD symptoms in older adults. There also appears to be a dose-response relationship between cumulative trauma exposure and severity of PTSD symptoms in later life. Clinical implications of these findings for working with older adults are discussed. These include the importance of designing prevention and early interventions services for older adults at risk of PTSD, comprehensive screening for PTSD symptoms and further development of psychological interventions specifically targeting emotion regulation strategies

A software application for the assessment of inattention and delirium.

Background Delirium is an acute neuropsychiatric syndrome characterised by fluctuating course, acute onset, and inattention. Despite being associated with adverse outcomes, including higher mortality, delirium is severely under-diagnosed with as many as 75% of cases missed in acute hospitals. The reasons for under-detection of delirium include lack of reliable measures and symptom overlap with dementia. Recently, the Edinburgh Delirium Test Box (EDTB), employing tasks of sustained attention, has been validated as an objective screening tool for detecting delirium and distinguishing it from dementia. The primary aim of the current study evaluated the feasibility and validity of a smartphone adaptation of the EDTB known as the DelApp. Methods The first phase of this study recruited 18 cognitively normal patients and 2 patients with dementia to evaluate the feasibility of using a smartphone application in the elderly patients. Patients performance on the DelApp was compared to their performance on the EDTB. In the second phase, the DelApp was administered to 3 groups of hospital patients: (1) cognitively normal controls (n=54); (2) patients with dementia but no current delirium (n=52); and (3) patients with delirium (n=50). Delirium was diagnosed using traditional methods. Arousal, depression, cognitive impairment and attention were further assessed using conventional tests. Results First phase of the study indicated that the DelApp is a feasible way of measuring inattention. In the second phase, delirium patients (median=6, IQR=4-7) performed significantly worse on the DelApp than those with dementia (median=10, IQR=9-10; p<.001) and controls (median=10, IQR=10-10; p<.001), which was associated with delirium severity (rs=-0.73, p<0.0001). Receiver operating characteristic analysis indicated that the DelApp was 98% sensitive and 94% specific to delirium. Deficits in sustained attention were also associated with depression and abnormal levels of arousal. Conclusions These results indicate the utility of objective assessment of sustained attention in identifying delirium and differentiating it from dementia. The DelApp showed a promising potential as an objective tool for diagnosing delirium. This research also highlights the importance of controlling for arousal and depression, when assessing inattention in delirium

The relationship between interoception and psychological outcomes: A mind-body intervention in patients with pulmonary hypertension

Background Pulmonary hypertension is a rare and incurable condition characterised by fatigue and breathlessness. The effects of pulmonary hypertension has a significant impact on an individual’s emotional wellbeing and there are currently no established psychological interventions to improve this. Interoception is defined as the ability to perceive the internal state of the body and emerging research suggests that interventions to improve interoception can improve well-being. Aims The project aims to develop an interoceptive based intervention for those with pulmonary hypertension and examine the feasibility and acceptability of this. Additional aims are to explore the preliminary results of the intervention. Methods A randomised control feasibility trial will be used. Thirty-two participants will be included. Participants will be patients within the Scottish Pulmonary Vascular Unit diagnosed with pulmonary hypertension and randomly assigned to either the intervention or control (waitlist) group. The intervention will be an eight-session online group and participants will complete measures for interoception, anxiety, depression, health related quality of life, as well as a feasibility and acceptability questionnaire. Quantitative analysis will include descriptive statistics and T-tests (including non-parametric versions) to analyse the feasibility and gain a preliminary understanding of the intervention. Practical Applications It is hoped that the findings will identify a sample size for a larger trial whilst also informing future clinical practice. This project will be written up for a suitable journal and will be presented at an appropriate conference