**1. Introduction**

Since the introduction of the latest version of the Diagnostic and Statistical Manual (DSM-5; [1]), Post-Traumatic Stress Disorder or PTSD takes a central position among stress-related disorders. This distressing and demoralizing disorder is triggered by exposure to a life-threatening or terrifying event, experienced in person or witnessed indirectly. The symptoms needed for a diagnosis are summarized as involuntary re-experiencing the adverse event(s), efforts to avoid such intrusive memories, negative cognitions or mood alterations, and increased arousal [1]. Although PTSD is precipitated by exposure to a severe life event, it is not clear

why some people develop PTSD after potentially traumatic events (PTEs), while others do not. Several risk factors have been found, such as prior exposure to (and the number of types of) traumatic events [2], neuroticism, lack of social support or being female [3].

Although the percentage of older adults meeting full diagnostic criteria for this disorder appears to be lower than in younger adults [3, 4], PTSD among them often presents a serious condition [5] with high comorbidity rates [6] and showing a chronic, fluctuating course [7]. As older adults present the fastest-growing segment in the world population, evidence-based treatment approaches are required to address the needs of trauma-affected older populations. After all, PTE's can occur during all stages of life. Moreover, since populations of older adults not only grow in size, but also in life expectancy, trauma-related psychotherapy in later life can be followed by many more years to live.

In older adults, however, the symptoms are often misunderstood as depression, anxiety, somatic illness or memory problems due to aging. Consequently, PTSD has been described as a 'hidden variable' in the lives of older adults suffering from such a confusing array of symptoms [8]. Psychotherapy for older PTSD patients has been found to encounter several more barriers. To start with, long-standing stereotypes regarding older adults' capacity to change present a broadly generalized example of agism (age-related discrimination). Due to Freud's assumptions on psychoanalysis [9], advancing age was long considered a disadvantage in psychotherapy. Furthermore, low recognition of PTSD in primary care [5, 10], the reluctance of older adults to accept services of mental health professionals to deal with their problems [11] and insufficient empirical data [12] play a role. Taken together, in an age of a growing population of older adults, those suffering from PTSD risk receiving less-than-optimally efficacious treatment, which may be considered a research gap as well as a clinical problem challenging both researchers and clinicians.

Regarding trauma-related psychotherapy in later life, recent case studies reported encouraging results [13–15]. Trauma-focused exposure seemed to be well tolerated without adverse effects on comorbid cardiac conditions [16]. Some small controlled studies yielded preliminary positive treatment results for PTSD [17–19], although the small sample sizes did not allow for definitively bridging the research gaps. More robust studies [20, 21] suggested that (variants of) Trauma-Focused Cognitive Behavioral Therapy (TF CBT) can be safely and effectively used with older adult PTSD patients [22]. It must be realized, however, that the generalizability of those conclusions may be limited by the fact that most research has been conducted in Western countries, predominantly among Holocaust survivors or aging male military veterans. In addition, most studies are poorly reflective of the demographic context, as they do not include sufficient participants over the age of 74 [23].

To strengthen the existing evidence, a set of three studies (including a randomized controlled trial or RCT) was conducted, comparing treatment effects for PTSD of two psychotherapeutic interventions in treatment-seeking older adults with PTSD in the Netherlands [24], an exploratory analysis of self-reported symptoms and resilience measures in the same sample [25], and qualitative analysis of cognitions and emotions [26]. A global summary of these studies and their findings will allow for discussing current developments in the field of treating trauma-related disorders in later life.

*Treating Trauma-related Disorders in Later Life: Moving Forward DOI: http://dx.doi.org/10.5772/intechopen.102499*
