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This article is an examination of the empirical literature published in peer-reviewed journals, which investigated samples of adults aged 50 and older, who had experienced trauma, in childhood with follow-up of the impact on later life mental and physical health. Articles were identified through searches of EBSCO host databases, such as PubMed, SocioIndex, and PsychoLit. Search terms such as childhood trauma and cumulative trauma were paired with the term older adults in varying combinations. The collective findings of 23 studies published between 1996 and 2001 suggested that trauma first documented as occurring in childhood is associated with later life mental and physical health. Methodological limitations and future directions as well as recommendations for practice, policy, and research with older adults and trauma are delineated.
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Traumatology
http://tmt.sagepub.com/content/early/2012/03/26/1534765612437377
The online version of this article can be found at:
DOI: 10.1177/1534765612437377
published online 16 April 2012Traumatology
Tina Maschi, Judith Baer, Mary Beth Morrissey and Claudia Moreno
The Aftermath of Childhood Trauma on Late Life Mental and Physical Health: A Review of the Literature
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Introduction
One or more traumatic experiences in childhood (below
the age of 18) is a dramatic event with varying short- and
long-term consequences (Gagnon & Hersen, 2000; Kraaij,
Kremers, & Arensman, 1997). Rates of trauma from the
National Comorbidity Study revealed that more than half
of Americans between 18 and 55 reported experiencing at
least one earlier traumatic life event (Kessler, Sonnega,
Bromet, Hughes, & Nelson, 1995). Moreover, the psycho-
logical effects of such events are notable as global rates of
posttraumatic stress disorder (PTSD) have been reported to
be as high as 20% based on either DSM-IV-TR or ICD-10
diagnostic codes (APA, 2000; Elhai, Grubaugh, Kashdan,
& Frueh, 2008; Shmotkin & Barilan, 2002).
Traumatic events are broad in scope, range in intensity,
and at times, there is a dosage effect. People’s experiences of
trauma range from a singular childhood event to the accumu-
lation of a series of traumatic experiences that occur across
the life course. Examples include ongoing physical and sex-
ual assault or being a victim and/or witness to community
violence or terrorist attacks. A person’s subjective response
to traumatic events may be psychological, and/or physiologi-
cal and survivors may be affected in a variety of ways across
the different stages of the life span: childhood, adulthood,
and older adulthood (Elder, 2003; Pearlin, Schieman, Fazio,
& Meersman, 2005).
Trauma and Mental and Physical Health
Research indicates that childhood trauma may have a persis-
tent or intermittent mental or physical effect. The effects
may include continued revictimization, psychiatric disor-
ders, cognitive impairment, maladaptive stress responses,
physical disabilities, and even early death (Acierno et al.,
2010; Gagnon & Hersen, 2000; Stessman et al., 2008). Other
stressful life events, such as losing a loved one, school fail-
ure, or family problems may occur concurrently or sequen-
tially, at various points across the life course, and when this
stress happens it often exacerbates subjective symptoms
(Maschi, 2006a).
The type and timing of symptoms may vary. For example,
subjective traumatic experiences that first occur in childhood
may be accompanied by feelings of intense fear, helpless-
ness, or horror (APA, 2000; Hiskey, Luckie, Davies, &
Brewin, 2008). Any of these subjective feelings may occur
437377TMTXXX10.1177/1534765612
437377Maschi et al.Traumatology XX(X)
1
Fordham University Graduate School of Social Service, New York, NY,
USA
2
Rutgers University School of Social Work, New Brunswick, NJ, USA
Corresponding Author:
Tina Maschi, Fordham University, 420 Montgomery Street, Highland Park,
NJ 08904, USA
Email: tmaschi@fordham.edu.
The Aftermath of Childhood Trauma
on Late Life Mental and Physical Health:
A Review of the Literature
Tina Maschi
1
, Judith Baer
2
, Mary Beth Morrissey
1
, and Claudia Moreno
1
Abstract
This article is an examination of the empirical literature published in peer-reviewed journals, which investigated samples of
adults aged 50 and older, who had experienced trauma, in childhood with follow-up of the impact on later life mental and
physical health. Articles were identified through searches of EBSCO host databases, such as PubMed, SocioIndex, and PsychoLit.
Search terms such as childhood trauma and cumulative trauma were paired with the term older adults in varying combinations.
The collective findings of 23 studies published between 1996 and 2001 suggested that trauma first documented as occurring
in childhood is associated with later life mental and physical health. Methodological limitations and future directions as well
as recommendations for practice, policy, and research with older adults and trauma are delineated.
Keywords
lifetime trauma, childhood trauma, earlier life trauma, stressful life events, mental health, anxiety, depression, physical health,
older adults
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2 Traumatology XX(X)
immediately following the childhood traumatic event or
remain dormant and then surface and even resurface in later
life (Hiskey et al., 2008). Evidence also suggests that when a
traumatic experience is marked by intensity, duration, and
chronicity, such as a prolonged exposure to war and impris-
onment, the likelihood of posttraumatic stress symptoms is
prolonged and may extend into advanced years (Neal, Hill,
Hughes, Middleton, & Busuttil, 1995). A cogent example
consists of a sample of World War II combat veterans and
ex-war prisoners (N = 30). Neal and colleagues (1995) found
that one third had PTSD diagnosis, and almost all (90%)
reported PTS symptoms 50 or more years later.
Research on the temporal effects of childhood trauma,
especially on later life functioning, has been minimally
explored. Although the data are scant, findings indicate that
childhood trauma exposure may result in minor psychologi-
cal distress or lead to more severe mental health conse-
quences, such as PTSD, depression, anxiety, and cognitive
impairment (e.g., Neal et al., 1995; Shmotkin & Litwin,
2009). The temporal aspects of survivors’ subjective
responses may be temporary, persistent, or delayed only to
resurface later in life, especially if a new traumatic experi-
ence occurs (Acierno et al., 2007, 2010; Brady, Acierno,
Resnick, Kilpatrick, & Saunders, 2004). Early life trauma
has been associated with later life physical health, including
the presence of chronic health problems, such as heart dis-
ease, diabetes, and mortality. Other health-related factors
include higher usage of psychotropic medications, reduced
capacity in activities of daily living, and poorer ratings on
self-reported health activities of daily living (Draper et al.,
2008; Petkus, Gum, King-Kallimanis, & Wetherell, 2009;
Stessman et al., 2008).
The broad scope of early traumatic experience is also evi-
dent in risk behavior studies. Research within the past decade
shows that early life trauma subsequently affects health risk
behaviors (Sachs-Ericsson et al., 2010; Stessman et al., 2008;
Vielhauer & Findler, 2002). These risk behaviors include
substance use, sexual activity, and heightened stress
response, which may further compromise later life physical
and mental well-being (Acierno et al., 2007; Bright &
Bowland, 2008; Haugebrook, Zgoba, Maschi, Morgen, &
Brown, 2010). Similarly, older adults with earlier life trauma,
have been shown to have a higher risk of revictimization or
elder abuse, especially if their social support network is lim-
ited (Acierno et al., 2007).
Purpose of the Study
Most of what is known about the short- and long-term men-
tal health and physical consequences of trauma is based on
younger populations specifically samples of children, ado-
lescents, and adults below the age of 50 (e.g., Browne &
Finkelhor, 1986; Maschi, 2006a, 2006b; Maschi, Morgen,
Zgoba, Courtney, & Ristow, 2011; Widom, 1989). There is a
small but growing body of research that has documented the
later life influence of childhood trauma among adults aged
50 and older (e.g., Acierno et al., 2010; Krause, 2004).
However, much remains unclear about the ways in which
traumatic events that occurred early in life influence later
life adaptive functioning (Van Zelst, Beurs, Beekman, Deeg,
& Van Dick, 2003). This knowledge gap is particularly
troublesome given that mental and physical health needs
become increasingly more complex and costly as individuals
age. Unidentified and untreated risk factors, such as trauma
and stressful life events, that may compromise individuals’
later life health and well-being need to be addressed, espe-
cially given the demographic data which show that older
adults are expected to reach unprecedented proportions of
the U.S. population. In addition, there is a dearth of informa-
tion about factors and processes that comprise the interven-
ing mechanisms that foster resilience across the life course.
Identifying these factors and processes can help prevent or
ameliorate later life adverse mental and physical health con-
sequences, especially among often overlooked vulnerable
populations, such as older adults.
To date, there is no known comprehensive review of the
literature that has examined later life mental and physical
health associated with traumatic experiences that first
occurred in childhood. The aim of this literature review was
to address that knowledge gap by examining the published
empirical literature regarding the effects of childhood trauma
on mental and physical health. The information gained from
this review can be used to identify factors that foster risk and
resilience across the life course. Such information is critical
for theory building and for delineating trauma assessment
processes and intervention strategies for older adults, espe-
cially in the movement toward increasing integration of pri-
mary care, mental health, and palliative care (Miller, Kessler,
Peek, & Kallenberg, 2011).
Method
Sample Selection
A comprehensive review of the empirical literature was con-
ducted to identify peer-reviewed journal articles that exam-
ined trauma which first occurred in childhood and the
subsequent concomitants in health and mental health in
samples aged 50 and older. Journal articles were located
through a search of electronic databases. The search engine
EBSCO Host was used because it housed 59 research data-
bases of particular relevance to the trauma literature, that is,
Academic Search Complete, PsychARTICLES, socINDEX,
and MEDLINE. Keyword search terms that were used in
various combinations, included childhood trauma, cumula-
tive trauma, and older adults and were limited to studies
published in the past 25 years (1996-2011).
A journal article was selected for inclusion in this study if
(a) it was a peer-reviewed empirical study (i.e., used quanti-
tative, qualitative, or mixed methods) that included a sample
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Maschi et al. 3
of adults aged 50 and older, (b) it examined trauma that first
occurred in childhood and the resultant consequences on
later life mental and or physical health, and (c) it was pub-
lished in a peer-reviewed social science or science journal in
the past 25 years (1996-2011). Based on this criteria, a total
of 23 articles were identified. Articles that were excluded
from the sample included studies with samples younger than
the age of 50, that did not examine trauma where at least one
event occurred during childhood, or that were not empirical
ones. A data-extraction tool was created by the research team
to organize information related to the methods and major
findings of the research studies.
Methods Used Across Studies
Design Types and Sampling Strategies
As shown in Table 1, the studies included in the review were
conducted over the past two decades between 1986 and
2008. Fifteen studies reported the year they were conducted,
5 were conducted between 1996 and 2000, and 10 studies
were conducted within the past decade between 2002 and
2008. Most of the studies used quantitative research meth-
ods (n = 20) with cross-sectional designs (n = 18). Slightly
more than half (n = 14) of the studies also used probability
sampling strategies that included some type of randomized
procedures. This included the use of nationally or regional
representative samples drawn from the United States (n = 15)
or Israel (n = 4). However, in many cases, response rates were
not provided or fell below an optimal 70%. In addition, the
use of group experimental designs was in the minority (n = 5).
The definitions for trauma also varied across studies and
data-collection methods were mostly in-person semistruc-
tured or structured interviews. As shown in Table 2, the
sample sizes varied widely from small (n = 12) to large (n =
21,877). The age of participants varied across studies rang-
ing from age 50 to above 90 years old. As for gender and
race, women and Whites comprised the majority of the study
samples.
Major Findings Across Studies
Correlates and Consequences
Table 3 provides a brief overview of the major findings of
trauma that first occurred in childhood and later life mental
and physical health concomitants. These collective findings
suggest that a history of childhood trauma is significantly
associated with later life mental health (including substance
abuse), physical health, and revictimization (Acierno et al.,
2010; Shmotkin & Barilan, 2002; Shmotkin & Litwin,
2009). These traumatic experiences ranged from a single
event to the accumulation of multiple traumatic and related
stressful life events. An earlier life singular traumatic event
of significant magnitude linked to later life adverse mental
and physical health among older adults included being a
childhood victim of physical or sexual assault or a child
holocaust or war survivor (Lamet, Szuchman, Perkel, &
Walsh, 2009; Shmotkin & Barilan, 2002).
Childhood trauma types and later life outcomes. As shown in
Table 4, the types of childhood trauma experienced and the
relationship to later life mental and physical health outcomes
varied across studies. Being a direct victim of violence as
compared with witnessing violence was found to have more
adverse mental health effects (Draper et al., 2008). Shmotkin
and Barilan (2002) found that direct trauma exposure had a
positive association with symptoms of depression among a
sample of older adults. In contrast, indirect trauma exposure
had either no association or an inverse association with
depression.
PTSD. Older adult survivors of childhood trauma, when
compared with older adults who did not experience trauma,
were more likely to experience posttraumatic stress symp-
toms (Brady et al., 2004). This is especially shown for symp-
toms of avoidance and reexperiencing symptoms (Acierno
et al., 2007). Reexperiencing trauma-related symptoms in later
life varied from a spontaneous experience with no associated
trigger to being triggered by other later life stressors, such as
widowhood or witnessing or learning about a terrorist attack
(Hiskey et al., 2008). More specifically, Hiskey and col-
leagues (2008) found that older adults, who were childhood
trauma survivors, experienced later life reactivation of trau-
matic memories, which had intense and vivid aspects with
the same subjective potency experienced during the actual
traumatic event. Many participants’ resurfaced memories
were triggered by sensory reminders or anniversaries of the
traumatic experiences. Brady et al. (2004) similarly found
that older adult widows with childhood trauma histories
compared with older adult nonwidows with childhood
trauma histories showed significantly higher levels of PTSD
symptoms. Likewise, Lamet et al. (2009) found that holo-
caust survivors reported higher posttraumatic symptoms
than nonholocaust survivors in the post-9/11 environment.
Singular and cumulative effects. Findings also suggest that
trauma histories can consist of one or more traumatic events
that first occurred in childhood. Participants, who experi-
enced multiple traumatic events, such as being a victim of
physical or sexual abuse, may have experienced these events
concurrently or sequentially along with other stressful life
events, such as living in poverty, loss of a loved one, and/or
school or employment problems.
The developmental period during which the trauma
occurred coupled with the type of traumatic experience may
have differential effects. For example, Draper and colleagues
(2008) found that older adults with childhood physical and
sexual abuse histories were at the highest risk of later poor
physical health and mental health compared with those who
did not have these experiences. As for life-course cumulative
effects, Yehuda and colleagues (1995) found that childhood
trauma combined with current experiences of age-related
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Table 1. Overview of Research Designs Across Studies That Examined Earlier Life Trauma and Late Life Mental and Physical Health Among Older Adults (N = 23)
Author(s) and year
(in alphabetical order)
Purpose of study
Study setting
Design and sampling strategies
Data-collection procedures
Acierno et al. (2007) Examine older adults with childhood
trauma histories, mental health, and
substance abuse
Continental United States; National
Women’s Study (1995-1996)
Quantitative; cross-sectional survey
descriptive design; national
representative subsample
Stratified random-digit-dialing;
standardized computer-assisted
telephone interviews; self-report
Acierno et al. (2010) Examine correlates of elder abuse,
such as prior childhood trauma
Continental United States; National
Elder Mistreatment Study (2008)
Quantitative; cross-sectional survey
descriptive design; nationally
representative older sample stratified
by geographic area
Stratified random-digit-dialing;
standardized computer-assisted
telephone interviews; self-report
Armour (2010) Examine meaning making among
holocaust survivors who immigrated
to the United States
U.S. locations (Austin, Dallas, Houston,
Los Angeles, Minneapolis, New Jersey,
San Antonio, Washington, DC)
Mixed methods; cross-sectional design;
nonprobability snowball sampling of
holocaust survivors
Mental health professionals
conducted 2-2.5-hr interviews.
Answers were recorded in an
interview protocol book and audio-
taped and transcribed verbatim
Brady, Acierno, Resnick,
Kilpatrick, and
Saunders (2004)
Investigate if older women’s widow
status was associated with prior
trauma, PTSD, depression
Continental United States; National
Women’s Study (1995-1996)
Quantative; cross-sectional survey
descriptive design; nationally
representative subsample
Stratified random-digit-dialing;
standardized computer-assisted
telephone interviews; self-report
Bright and Bowland (2008) Evaluate Posttraumatic Diagnostic
Scale for older women
Saint Louis Missouri community
setting
Mixed methods; cross-sectional design;
purposive sample drawn from larger
intervention study
In-person screening interview of
60-90 min (master’s degree)
clinicians; self-report
Draper et al. (2008) Examine association between child
abuse and mental and physical health
with older people
Australia; Depression and Early
Prevention of Suicide in General
Practice Survey
Quantitative; cross-sectional
randomized control trial design
Baseline-mailed questionnaire sent
to general practitioners’ patients;
self-report
Dulin and Passmore (2010) Examine mediating influence of trauma
avoidance on lifetime trauma, anxiety,
and depression
New Zealand community setting Quantitative/cross-sectional descriptive
design; nonprobability sample
(recruitment via advertisements)
Telephone interview questionnaires
completed; self-report
Haugebrook, Zgoba, Maschi,
Morgen, and Brown (2010)
Describe trauma, mental and physical
health, and substance use in older
prisoners
New Jersey Department of
Corrections (2009)
Quantitative; cross-sectional descriptive
study; randomized sample of older
prisoners
Case record reviews
Hiskey, Luckie, Davies, and
Brewin (2008)
Examine reactivated trauma memories
in older adults
London, England, Psychology
Department (2005-2006)
Quantitative; cross-sectional descriptive
study
In-person semistructured interviews;
self-report
Kraaij, Kremers, and
Arensman (1997)
Examine lifetime trauma and
depression in older adults
Holland, nursing home, or service
apartments
Quantitative; cross-sectional descriptive
study; 43% response rate
In-person interviews with trained
students in psychology; self-report
Krause (2004) Examine lifetime trauma, emotional
support, life satisfaction, and age
group
Continental United States, Wave 4
(2002-2003); Medicare Beneficiary
Eligibility List
Quantitative; cross-sectional survey
descriptive design; probability
sampling; drawn from Medicare list
(noninstitutional; English-speaking,
aged 65+, retired); 54% response rate
In-person structured clinical
interview; data collected by Harris
Interactive (New York, NY); self-
report
Krause, Shaw, and
Cairney (2004)
Examine the relationship between
lifetime trauma and physical health
status
Continental United States, Wave 4
(2002-2003); Medicare Beneficiary
Eligibility List
Quantitative; cross-sectional survey
descriptive design; probability
sampling; drawn from Medicare list
(noninstitutional; English-speaking,
aged 65+, retired); 54% response rate
In-person structured clinical
interview; data collected by Harris
Interactive (New York, NY); self-
report
(continued)
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Table 1. (continued)
Author(s) and year (in
alphabetical order)
Purpose of study
Study setting
Design and sampling strategies
Data-collection procedures
Krause, Shaw, and Cairney
(2004)
Evaluate the stress-buffering function
of meaning of life
Continental United States, Waves
4-5 (2002-2003, 2005); Medicare
Beneficiary Eligibility List
Quantitative; longitudinal survey
descriptive design; Medicare list
(noninstitutional; English-speaking,
aged 65+, retired); 54% response rate
In-person structured clinical
interview; data collected by Harris
Interactive (New York, NY); self-
report
Lamet, Szuchman, Perkel, and
Walsh (2009)
Examine retraumatization and the risk
factors, resilience, and psychological
distress (post-9/11)
Florida, private homes and senior
centers (post-9/11)
Quantitative; cross-sectional; quasi-
experimental comparison group
design of holocaust and nonholocaust
survivors
In-person interviews administered
in private homes or senior center;
self-report
Nelson-Becker (2004) Explore older adults trauma and stress
coping
Chicago, Illinois-4 subsidized
high-rise housing facilities
Qualitative; cross-sectional
nonprobability purposive sample
In-person audio-taped interviews;
self-report
Petkus, Gum, King-Kallimanis,
and Wetherell (2009)
Examine trauma, physical health,
anxiety, depression in homebound
older adults
Central Florida state and federally
funded aging services
Quantitative; cross-sectional; secondary
data analysis; nonprobability sample
recruited by in-home aging service
case managers
In-person structured clinical
interview; self-report; case
managers’ standard assessment of
health and functioning
Sachs-Ericsson et al. (2010) Explore impact of childhood trauma
on internalizing behavior and self-
esteem
Florida-Miami Dade County–The
Physical Health & Disability Study
(1986 & 1989)
Quantitative; longitudinal; secondary
data analysis; probability 10,000
randomly selected households; equally
proportioned by gender, race, and
disability status
In-home in-person interviewers
(retrospect self-report) by trained
bilingual interviewers; some use of
alternative sites or by telephone
Schnurr, Spiro, Aldwin, and
Stukei (2002)
Examine the prior trauma and PTSD
in older adults
Boston, Massachusetts; Boston
Veteran Affairs (1990)
Quantitative; longitudinal design;
stratified random sampling of healthy
veterans of World War II; oversampled
for combat or civilian trauma
Mailed questionnaire followed by
audio-taped in-person or telephone
interviews by clinicians; self-report
Shmotkin and Barilan (2002) Explore holocaust experience,
psychological distress, and health
Tel Aviv, Israel; large public hospital
(1996-2000)
Mixed methods; longitudinal-intake
and follow-up; purposive sample of
holocaust survivor in treatment with
a physician
In-person interviews with participants;
physician intake and follow-up
information
Shmotkin and Litwin (2009) Examine association between
cumulative adversity and current
depressive symptoms
Israel; Survey of Health, Aging, and
Retirement in Europe (SHARE;
2005-2006)
Quantitative; cross-sectional secondary
data analysis; representative
sample stratified by geographic and
demographic criteria
In-person interviews (Hebrew,
Russian, Arabic); computer-assisted
personal interviews (90 min);
supplementary paper drop-off
questionnaire; self-report
Stessman et al. (2008) Examine whether holocaust exposure
affects physical health and mortality
West Jerusalem, Israel; Jerusalem
Longitudinal Cohort Study;
Electoral Registry (1990 & 1997)
Quantitative; longitudinal cohort study;
randomly selected comparison group
design; West Jerusalem residents born
1920-1921
Two 90-min in-person structured
interviews (self-report); review
of hospital admission records and
death certificates issued in Israel
Van der Hal-Van Raalte,
Bakermans-Kranenburg, and
Van Ijzendoorn (2008)
Examine stress reactivity in holocaust
survivors
Israel; Amcha Center for Holocaust
Survivors and participants’ home
Quantitative; longitudinal (time series)
nonprobability sampling; comparison
group design; sample recruited from
Israel Ministry of Interior Affairs;
holocaust survivors and comparisons
Research assistants–administered
multiple cortisol assessments and
in-person self-report questionnaires
Yehuda, Kahana, Schmeidler,
Southwick, Wilson, and Giller
(1995)
Examine late-life implications of early
traumatic stress, PTSD, among
survivors and comparisons
Cleveland, Ohio; Cleaveland
Historical Society
Quantitative; cross-sectional random
selection of holocaust survivors from
Cleveland Historical Society roster
In-person structured clinical
interviews
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Table 2. Sample Characteristics Used Across Studies: Sample Size, Age, Gender, and Race/Ethnicity (N = 23)
Gender Race/ethnicity
Author/s and year (in alphabetical order) Sample size Age Women Men White AA Latino
Asian,
NA, PI* Other
Acierno et al. (2007) N = 549 55+ 100% 0% 88% 7% 3% 2% 4%
Acierno et al. (2010) N = 5,777 60+ 60% 40% 88% 7% 4% 2% 0.2%
Armour (2010) N = 133 80+ 68% 32% 100% 0% 0% 0% 0%
Brady, Acierno, Resnick, Kilpatrick, and Saunders (2004) N = 473 55-89 100% 0% 89% 7% 0% 5% 0%
Bright and Bowland (2008) N = 33 54-83 100% 0% 89% 10% 0% 0.5% 0.5%
Draper et al. (2008) N = 21,819 M = 72.0 (SD = 7.7) 59% 41% N/R N/R N/R N/R N/R
Dulin and Passmore (2010) N = 1,489 65-94; M = 74.2 67% 34% 86% 0% 0% 3% 11%
Haugebrook, Zgoba, Maschi, Morgen, and Brown (2010) N = 114 55+ 8% 92% 36% 48% 16% 0% 0%
Hiskey, Luckie, Davies, and Brewin (2008) N = 12 M = 74.6 (SD = 5.9) 33% 67% 100% 0% 0% 0% 0%
Kraaij, Kremers, and Arensman (1997) N = 171 68-97; M = 82.3 (SD = 6.7) 75% 25% N/R N/R N/R N/R N/R
Krause (2004) N = 1,397 65-85+; M = 74.7 (SD = 7.4) 58% 42% 89% 0% 0% 0% 11%
Krause, Shaw, and Cairney (2004) N = 1,508 65-85+; M = 74.7 (SD = 7.4) 58% 42% 89% 0% 0% 0% 11%
Krause et al. (2010) N = 1,478 65-85+; M = 74.7 (SD = 7.4) 59% 41% N/R N/R N/R N/R N/R
Lamet, Szuchman, Perkel, and Walsh (2009) N = 128
(n = 60; holocaust)
80-93 100% 0% 100% 0% 0% 0% 0%
Nelson-Becker (2004) N = 79 58-92; M = 77.4 (SD = 8.0) 84% 16% 47% 53% 0% 0% 0%
Petkus, Gum, King-Kallimanis, and Wetherell (2009) N = 136 N/R N/R N/R N/R N/R N/R N/R N/R
Sachs-Ericsson et al. (2010) N = 1,460 (t1);
N = 1,090 (t2)
50+; M = 67.0 (SD = 10.3) 60% 40% 22% 34% 44% 0% 0%
Schnurr, Spiro, Aldwin, and Stukei (2002) N = 436 59-92 0% 100% 98% 0% 0% 0% 2%
Shmotkin and Barilan (2002) N = 38 55-86; M = 72.0 (SD = 9.2) 55% 45% N/R N/R N/R N/R N/R
Shmotkin and Litwin (2009) N = 1,710 N/R N/R N/R N/R N/R N/R N/R N/R
Stessman et al. (2008) N = 458
(n = 222; holocaust)
70 (at baseline);
77 (at follow-up)
50% 50% 100% 0% 0% 0% 0%
Van der Hal-Van Raalte, Bakermans-Kranenburg,
and Van Ijzendoorn (2008)
N = 133 64-73; M = 65.0 61% 39% N/R N/R N/R N/R N/R
Yehuda, Kahana, Schmeidler, Southwick, Wilson, and
Giller (1995)
N = 121
(n= 72; holocaust)
M = 66.4 (SD = 5.9-holocaust);
M = 70.4 (SD = 6.8-comparison)
N/R N/R N/R N/R N/R N/R N/R
Note: AA = African American; Asian, NA, PI = Asian American, Native American, or Pacific Islander; N/R = not reported.
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Maschi et al. 7
stress was positively associated to the severity of posttrau-
matic stress symptoms. That is, survivors with PTSD
reported higher levels of cumulative trauma and stressful life
events compared with comparison group of survivors with-
out PTSD.
Comorbid mental and physical effects. Childhood trauma
survivors in later life also may experience comorbid mental
and physical health effects. Petkus et al. (2009) found that
older adults with earlier life trauma histories that included
childhood trauma had clinically significant somatic and anx-
iety symptoms, were diagnosed with anxiety, had one more
chronic health condition, took two or more psychotropic
medications, and had lower self-reported health than a com-
parison group of older adults without trauma histories.
Age group differences or cohort effects. Some studies that
examined earlier trauma found age group differences, espe-
cially with physical health. For example, Krause, Shaw, and
Cairney (2004) found the cumulative effects of life-course
traumatic events, including events from childhood, exerted
an adverse effect on each of the three health measures among
young-old (ages 65-74), old-old (ages 75-84), and oldest-old
(ages 85 and older) adults.
Age group differences also were found in that the youngest-
old appeared to be at greatest risk of later life victimization
and mental health problems. Acierno et al. (2010) found that
the “younger” older adults (aged 55-60), who were child-
hood trauma survivors, were more at risk of elder abuse
compared with “older” old adults, who were childhood
trauma survivors. As for mental health, Van der Hal-Van
Raalte, Bakermans-Kranenburg, and Van Ijzendoorn (2008)
found that younger-old holocaust survivors (aged 56-60)
showed PTSD impairment with early onset of impaired
stress regulation compared with the older-old holocaust sur-
vivors (aged 61+).
Resiliency and Protective Factors
The collective study results also found some evidence for
factors that fostered resiliency across the life course among
older adults. These factors included internal and external
resources that included self-esteem, a sense of safety, spiri-
tuality, and forgiveness, positive attitudes (optimism), posi-
tive actions (agency), and social support.
Internal resources. Some studies found that internal
resources acted as protective factors that preserved later life
cognitive psychological health. For example, Sachs-Ericsson
and colleagues (2010) found that self-esteem moderated the
relationship between child abuse history and internalizing
disorders among older adults. Similarly, Lamet et al. (2009)
conducted a study on child holocaust survivors and com-
pared them with nonholocaust survivors. Results indicated
that internal resources, such as self-esteem, cognitive resil-
ience, positive attitude or optimism, spirituality, a sense of
safety, and forgiveness acted as protective factors.
Spirituality, “meaning-making,” and an intact sense of
safety also were found to foster later life resilience. Nelson-
Becker (2004) found that older adults commonly reported
that spirituality helped them to cope with past traumatic
experiences. Similarly, in a recent dissertation study of suf-
fering among frail elderly women (Morrissey, 2011a) and a
follow-up study (Morrissey, 2011b), Morrissey reported that
the maternal was an issue of significance for seriously ill
older adults for whom a struggle toward well-being at the
end of life had meanings of empathic maternal care, nurtur-
ance, comfort, and security in the context of life-course
experiences of traumatic loss, pain, and suffering. Krause
and colleagues (2004) found that older adults with histories
of cumulative trauma and stressful life events that first
occurred in childhood reported a stronger sense of meaning
Table 3. Overview of Major Findings That Examined Earlier Life Trauma and Late Life Mental and Physical Health Among Older Adults
Lifetime trauma (childhood or adulthood) Resilience or protective factors Health and well-being
Victim or witness to violence
Physical assault
Sexual assault
Emotional abuse
Mass trauma
Combat exposure
Related stressful life events (e.g., death of a loved one,
divorce, accidents, natural disasters)
Sociodemographic influences
Age
Gender
Race/ethnicity
Marital status
Education
Economic status
Religion
Social service use
Psychological/emotional/cognitive
Self-esteem
Life satisfaction
Reactivated trauma memories
Forgiveness
Meaning in life (meaning-making)
Sense of safety
Cognitive resilience
Spiritual
Spirituality
Social
Social support
Social resilience
Physical
Activity strengths and limitations
Behavioral
Traumatic stimuli avoidance
Fighting hatred and oppression
Mental health
PTSD
Depression
Anxiety
Psychiatric symptoms
Cognitive functioning
Physical health
Physical health conditions
Revictimization
Mortality
Cortisol levels
Functional status
ADLs
IADLs
Other physical activities
Subjective health
Self-rated health
Note: PTSD = posttraumatic stress disorder; ADL = activity of daily living; IADL = instrumental activity of daily living.
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Table 4. Major Findings of the Literature on Earlier Life Trauma and Late Life Physical and Mental Health Among Older Adults (N = 23)
Author(s)
(year)
Independent
variable/s
Mediator/moderator/
control variable(s)
Outcome
variables
Central measures used
Data analysis
Major findings
Acierno et al.
(2007)
Physical and sexual
assault histories
(childhood +)
None Alcohol abuse,
depressive,
and PTSD
symptoms
Structured interview about
trauma, perceived health
status, psychopathology,
demographics
Prevalence
rates, odds
ratios
Older women with physical or sexual assault histories
were more likely to present with alcohol abuse,
depression, and PTSD avoidance and reexperiencing
symptoms than comparison group
Acierno et al.
(2010)
Lifetime trauma
(emotional physical,
sexual) (childhood +)
Social support, age, gender,
race, income, ADLs,
social service use
Elder abuse:
emotional,
physical,
sexual,
financial,
neglect
Structured interview
schedule about lifetime
trauma, social support,
sociodemographics
Logistic
regression,
MANOVA
Younger older were more at risk of elder abuse
compared with older old. The most consistent
correlates of mistreatment across abuse types were
low social support and previous trauma
Armour (2010) Child holocaust survivor
status
Cognitive and social
resilience
Forgiveness Semistructured interview
questions; Standardized
Measures: Enright
Forgiveness Inventory;
Coping with Aftermath
of Holocaust; Life
History; Sense
Making; Perceptions
of Other Survivors
Questionnaires
Descriptive
and thematic
analysis
Content analysis themes related to attitudes and action
related to holocaust survival (during the holocaust,
U.S. immigration, and later life). During the holocaust,
survivors refused death as an option, felt lucky,
outwitted their captors, and had hope and a future
orientation. Post immigration, survivors focused on
education, success, family, closure, proactive beliefs
(gratitude and acceptance), and resolving hatred. As
older adults, their focus was on health maintenance,
family obligations, and fighting hatred and oppression
Brady, Acierno,
Resnick,
Kilpatrick, and
Saunders (2004)
Spousal death, trauma-
childhood +
None PTSD,
depressive
symptoms
Structured Clinical
Interview for DSM-III-R
Chi-square
analyses
Older adult widowed women experienced more PTSD
but not depressive symptoms than their nonwidowed
counterparts
Bright and
Bowland
(2008)
Sexual assault, domestic
violence (childhood +)
None PTSD, mental
health,
substance
abuse
Posttraumatic Diagnostic
Scale (PDS)
Descriptive
statistics
The women viewed trauma as bundles of interrelated
experiences with adverse consequences, such as
substance abuse, sexual activity, and mental health
issues. PDS scores were found to vary among a
sample of 9 older women, questioning its validity with
older women
Draper et al.
(2008)
Physical and sexual
abuse (childhood)
Age, sex, religion,
birthplace, marital
status, education, living
situation, parental death,
health behaviors, social
support
Current physical
health,
mental health,
anxiety and
depressive
symptoms
Medical Outcomes Study
Short Form; Common
Medical Morbidity
Inventories; Patient
Health Questionnaire;
Hospital Anxiety and
Depression Scale
Multivariate
models of
association
Older adult participants with child physical or sexual
abuse histories had greater risk of poor health and
mental health outcomes. Those with both physical and
sexual abuse histories had the highest risk of poor
health and mental health
Dulin and
Passmore
(2010)
Trauma (16 events, e.g.,
physical and sexual
abuse, loss-childhood
+)
Avoidance of potentially
traumatic stimuli
Depressive
and anxiety
symptoms
Traumatic Events
Questionnaire; Geriatric
Depression Scale;
Stanford Acute Stress
Reaction Questionnaire;
Civilian Version–PTSD
Checklist
Mediation-
hierarchical
regression
analyses
Traumatic events predict both depression and anxiety
among New Zealand older adults. Adult traumatic
events predicted late life anxiety and depression
compared with childhood and adolescence
(continued)
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9
Author(s)
(year)
Independent
variable/s
Mediator/moderator/
control variable(s)
Outcome
variables
Central measures used
Data analysis
Major findings
Haugebrook,
Zgoba, Maschi,
Morgen, and
Brown (2010)
Trauma (e.g., physical
and sexual abuse,
losing loved one-
childhood +)
Race/ethnicity Health, mental
health,
substance use
Data extraction form—
categories for trauma,
physical health, mental
health, and substance
abuse
Chi-square;
odds ratios
About 50% of the older prisoners had documented
trauma (being a victim or witness to violence) in
childhood. Physical health, mental health, and substance
use problems were common. White compared with
African American and Latino prisoners were found to
have significantly higher rates of reported trauma
Hiskey, Luckie,
Davies, and
Brewin (2008)
Trauma (e.g., fire, illness,
domestic violence,
assault accident-
childhood +)
Involuntary trauma
memories
PTSD,
depressive
symptoms
Trauma Memory
Inventory–Distant
Events; Post-Traumatic
Diagnostic and Geriatric
Depression Scales
Descriptive
statistics
Earlier life trauma memories contained intense and
vivid aspects, reflective of original event. Triggers, such
as sensory reminders or anniversaries, were noted.
Depression and PTSD symptoms were present in
some participants
Kraaij, Kremers,
and Arensman
(1997)
Traumatic and stressful
life events (childhood +)
None Depression Life Events Questionnaire
(96 questions); Geriatric
Depression Scale
Correlation
analysis
Most significant correlations with depression were
found for traumatic events that occurred in late
adolescence/adulthood. Some stressful life events
were correlated with depression
Krause (2004) 22 lifetime trauma and
stressful life events
(childhood +)
Emotional social support,
age, gender, marital status,
education
Life satisfaction Life Satisfaction–Index A
Scale; Lifetime Traumatic
Life Events Checklist;
Social Support Scale
Multiple
regression,
moderation
analyses
Prior exposure to trauma was associated with less life
satisfaction among the young-old (65-74), old-old (75-
84), and oldest-old (85+). Emotional social support
buffered oldest-old cohort
Krause, Shaw, and
Cairney (2004)
22 trauma and stressful
life events (childhood
+)
Age, sex, marital status,
education, race
Physical health
(problems,
functioning,
self-rated
health)
Lifetime Traumatic Life
Events Checklist; global
self-rated health (self and
others); satisfaction with
health; health conditions;
ADLs; IADLs
OLS multiple
regression
analyses
Traumatic events (including in childhood) exerted an
adverse effect on three health outcomes measures
among young-old (65-74), old-old (75-84), and oldest-
old (85+) adults. Data also showed youngest-old
appear to be at greatest risk.
Krause et al.
(2010)
22 trauma and stressful
life events (childhood
+)
Meaning in life, age, sex,
education, marital status
Depressive
symptoms
Lifetime Traumatic Life
Events Checklist; Center
for Epidemiologic Studies
Depression Scale; Meaning
in Life Scale
Multiple
regression
analyses;
cross-lagged
panel model
Meaning in life was found to reduce the adverse
consequences of traumatic and stressful life events
on depressive symptoms (cross-sectional, not
longitudinal)
Lamet, Szuchman,
Perkel, and
Walsh (2009)
Child holocaust Survivor
Status
Trait anxiety, sense of safety,
cognitive and social
resilience
PTSD Trauma Symptom Checklist;
Trait Anxiety Inventory;
Resilience Scale; Sense
of Safety Regarding
Terrorism Scale
MANOVA,
hierarchical
regression
analysis
Child holocaust survivors reported higher posttraumatic
symptoms than nonholocaust survivors in post-9/11
environment. Anxiety, sense of safety and survivor
status contributed significantly to posttraumatic
symptoms
Nelson-Becker
(2004)
Traumatic and everyday
life events (childhood
+)
Coping resources (e.g.,
spiritual)
Coping abilities Interview Schedule—open
ended questions about
life challenges and coping
abilities
Narrative
analysis
Older adults were found to identify coping resources,
including spirituality in their life narratives
Petkus, Gum,
King-Kallimanis,
and Wetherell
(2009)
Trauma (childhood +) Physical health, cognitive
functioning
Anxiety and
depressive
symptoms,
psychotropic
medication
use, self-report
health
Structured Clinical Inter-
view for DSM; Modified
Mini-Mental Status
Exam; Brief Symptom
Inventory, health and
functional status standard
assessments
t tests, chi-
square,
logistic
regression
analyses
Older adults with trauma histories had clinically
significant somatic and anxiety symptoms, anxiety
diagnosis, had one more chronic health condition,
taking two more psychotropic medications, lower self-
reported health than comparison group
(continued)
Table 4. (continued)
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10
Author(s)
(year)
Independent
variable/s
Mediator/moderator/
control variable(s)
Outcome
variables
Central measures used
Data analysis
Major findings
Sachs-Ericsson et
al. (2010)
Trauma (physical & sexual,
emotional-childhood)
Self-esteem, emotional
reliance, activity
limitations, family of
origin variables
Internalizing
disorders
(anxiety &
depressive
symptoms)
Semistructured Composite
International Diagnostic
Interview; Child Abuse
Scale; Rosenberg’s Self-
Esteem Scale; Emotional
Reliance Scale; ADL;
IADL; Family questions
Multiple
regression,
moderation
analysis
Child abuse history was found to predict later life
internalizing disorders. Self-esteem and not emotional
reliance was found to moderate the abuse and
internalizing disorder relationship
Schnurr, Spiro,
Aldwin, and
Stukei (2002)
10 trauma events
(childhood +)
None PTSD diagnosis
and symptoms
(current or
lifetime)
Brief Trauma Interview;
Clinician-Administered
PTSD Scale; PTSD
Checklist; Mississippi
Scale
Descriptive
analyses
Lifetime symptom severity was higher in those who met
DSM-IV A.2 criterion (intense fear, helplessness, or
horror) compared with those who did not
Shmotkin and
Barilan (2002)
Child holocaust status Holocaust experience (as
present or past)
Physical
morbidity and
functioning,
psychiatric
symptoms
Physical risk score; ADL
and IADL; chart review-
psychiatric diagnoses;
medication use; SCL-
90; Expressions of
Holocaust Experience
Correlation
and factor
analyses
Mental symptoms is positively associated with
participants’ holocaust-as-present experience
and negatively associated with holocaust-as-past
experiences. Holocaust-as-present high scores were
related to higher risk of morbidity
Shmotkin and
Litwin (2009)
(Trauma-17 events; victim
or witness)
Age, gender, origin,
education, income,
marital status, health
Depressive
symptoms
Traumatic Events
Inventory; European
Depression Scale; Center
for Epidemiological
Depression Scale
(adapted)
Hierarchical
multiple
regression
analyses
Self oriented adversity has a positive association with
symptoms of depression. Other-oriented adversity
had either no association or an inverse association
with depressive symptoms
Stessman et al.
(2008)
Child holocaust survivor
status
Social support, gender,
marital status, education,
ethnicity, economic status
Physical health,
mortality,
functioning,
depressive
symptoms,
cognition
Holocaust Status; Self-
Rated Health; Brief
Symptom Inventory;
Mini-Mental Status Exam;
Activities of Daily Living;
Instrumental Activities
of Daily Living; Mortality
records
Descriptive
and survival
analyses
Holocaust survivors compared with a control group
were more likely to have less social support, less
physical activity, greater difficulty in activities of daily
living, poorer self-rated health, and greater usage of
psychiatric medication
Van der Hal-
Van Raalte,
Bakermans-
Kranenburg, and
Van Ijzendoorn
(2008)
Child holocaust status Cortisol levels Physical health,
depressive
symptoms,
PTSD, survivor
experience
Cortisol Assessment; Physical
Health Scale; Beck’s
Depression Inventory;
Post Traumatic Diagnostic
Scale; Holocaust Survivor
Experience
Descriptive
analyses
Younger holocaust survivors (aged 56-60) showed
PTSD impairment with early onset of impaired stress
regulation compared with older holocaust survivors
(age 61+)
Yehuda, Kahana,
Schmeidler,
Southwick,
Wilson, and
Giller (1995)
Child holocaust status
(childhood + and past
year stress)
None PTSD Antonovsky Life Crises
Scale; Elderly Care
Research Center Life
Events Scale; Civilian
Mississippi PTSD Scale;
Clinician-Administered
PTSD Scale
ANOVA,
ANCOVA
PTSD severity was positively associated to cumulative
trauma and recent stress. Survivors with PTSD
reported higher levels of cumulative trauma and
current stress compared with comparison and non-
PTSD survivors
Note: PTSD = posttraumatic stress disorder; ADL = activity of daily living; IADL = instrumental activity of daily living.
Table 4. (continued)
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Maschi et al. 11
in life and lower levels of depressive symptoms. Lamet
et al.s (2009) results showed that an intact sense of safety
contributed significantly to less posttraumatic symptoms of
holocaust survivors in the post-9/11 U.S. terrorist attacks.
Positive attitudes and actions. Positive attitudes also were
found to be related to positive actions. Armours (2010)
mixed-methods study of holocaust survivors, who immi-
grated to the United States, found common themes across
participants that included positive attitudes (optimism) and
positive actions related to holocaust survival during the holo-
caust, U.S. immigration, and later life experiences in older
adulthood. For example, during the holocaust, survivors
reported that they refused death as an option, felt lucky, out-
witted their captors, and had a sense of hope for the future.
During their post U.S. immigration, survivors focused on
education, success, family, closure, proactive beliefs (grati-
tude and acceptance), and resolving hatred. As older adults,
their focus was on health maintenance, family obligations,
and fighting hatred and oppression.
Social support. Social support was another key social/envi-
ronmental coping resource that was examined. The presence
of social support in older adults’ lives was found to be a pro-
tective factor against elder abuse (Acierno et al., 2010). Emo-
tional social support was found to have a stress-buffering
effect for adults 85 and older on their life satisfaction. In addi-
tion, other studies found participants who reported a lack of
social support reported adverse physical and mental health
(Stessman et al., 2008). Stessman et al. (2008) found that
holocaust survivors, compared with a control group, were
more likely to have less social support, less physical activity,
greater difficulty in activities of daily living, poorer self-rated
health, and greater usage of psychiatric medication.
Discussion
The collective results of the studies that examined the later
life effects of childhood trauma showed that older adults,
who had experienced trauma in childhood, were at a higher
risk of later life victimization and adverse mental and physi-
cal health. Factors that fostered resiliency across the life
course consisted of internal and external resources that
included self-esteem, a sense of safety, spirituality and for-
giveness, positive attitudes (optimism), positive actions, and
social support. These findings offer directions for develop-
ing and improving theory and practice that address trauma
and stress across the life span.
Refining a Life-Course Theory of
Trauma and Resilience
The results of this review also suggest areas for theory
development, refinement, and testing that link childhood
trauma and stressful life events to later life outcomes via
individual and social pathways. Figure 1 illustrates prior
traumatic experiences and mental and physical health along
with the biological, cognitive, psychological/emotional, and
behavioral coping resources that influence mental and
physical health across the life course. Individuals’ responses
to traumatic experiences, such as being a victim of child-
hood sexual abuse, may be adaptive or maladaptive and
affect individuals’ biological (e.g., physiological stress
response), cognitive (e.g., beliefs, attitudes, spirituality),
emotional (e.g., anger or sadness), behavioral (e.g., diet,
substance abuse), and social (e.g., social support network)
well-being. A history of earlier life trauma and determinants
Traumac
Experiences
Stressful
Life Events
Mental Health
Physical Health
Life Experiences
Coping Resources
Mediang Pathways
Health &
Well-Being
Socio-
Demographic
Determinants
Moderang
Pathways
Biological
Cognive/
Spiritual
Psychological/
Emoonal
Behavioral
Social
Figure 1. A theoretical model of the impact of life-course trauma on health and well-being and mediating and moderating pathways that
increase or decrease cumulative risk
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12 Traumatology XX(X)
may affect the quality of later life mental health (e.g., PTSD,
depression, and anxiety) and physical health (e.g., chronic
disease, physical functioning, and mortality).
Theoretical integration. Existing theories can explain the
connection between earlier life trauma and later life out-
comes (Elder, 2003; Pearlin et al., 2005). It is possible for
these theories to be integrated and tested for further theoreti-
cal and research refinement. For example, an integration of
the life-course development and stress-process theories link
avenues where life events and cognitive processes intersect.
It is clear that responses to trauma are shaped by meaning,
coping, and other cognitive, emotional, and social processes
which are salient points for intervention strategies. Based on
Elders (1974) work, the life-course perspective argues that
significant life events, which are personal (e.g., sexual vic-
timization) or historical (e.g., global depression or world
war) influence the life-course trajectories of individuals.
Thus a theoretical integration of the life-course perspective
with cognitive and stress-processing theories would provide
an important lens to study the impact of early life trauma on
later life health and mental health profiles. Such a strategy
would result in an important new area of research inquiry.
Other mediating or moderating factors, such as sense of
control or mastery and social relationships, influence indi-
vidual and social development, including mental and physi-
cal health (Elder, 2003). This perspective enables us to
explore how traumatic experiences influence the mental and
physical health of individuals across their life course. The
life-course perspective involves examining contextual pro-
cesses such as culture, gender, socioeconomic status, health,
and mental health from a perspective of risk and resilient
factors. The ways and extent to which trauma and stress
influence life-course pathways have yet to be fully explored.
Stress-process theory informs life-course theory by
emphasizing the timing and sequencing of significant life
events and the ways in which they affect individuals’ life-
course trajectories. Individuals, who experience stable life
patterns that are consistent or continuous generally develop
relatively stable life-course trajectories (Pearlin et al., 2005).
In contrast, individuals who experience one or more difficult
periods of chaos or change such as childhood trauma, when
a relatively smooth life transition is expected, are exposed to
a heightened risk of adverse mental, physical, or behavioral
consequences. This especially applies to developmentally
sensitive periods in the life course. However, the adaptive
use of internal and external coping resources (e.g., positive
outlook or social support) may help foster a resilient response
over adverse experiences.
Tenets of these singular or integrated perspectives of life-
course and stress-process theories can be tested in future
research studies that can be used to inform prevention and
intervention efforts geared toward older adults. The overall
goal of such an integration of different theories is to achieve
a more inclusive and cohesive index of psychological and
health functioning during periods of the life span which have
been historically understudied.
Future Empirical Research Directions
The results of this review suggest a number of future direc-
tions for research. Future studies should examine the influ-
ence of life-course trauma and the individual and cumulative
impact of trauma and stressful life events. These studies
would be most useful if they included an evaluation of both
mental and physical health. Even more importantly, examin-
ing factors that foster resilience are essential. Future studies
that examine internal and external resources that may foster
resilience include personality traits, such as trait anxiety,
self-esteem, forgiveness, optimism, meaning in life, sense of
safety, and spirituality. Behavioral coping that includes
physical exercise and eating habits also are important pre-
ventive measures to examine as a protective coping resource.
Social coping should include measures for social support or
social resilience.
Future studies should also examine the influence of age,
gender, race/ethnicity, and culture (e.g., acculturation) on the
relationship of lifetime trauma to later life mental and physi-
cal health outcomes. Studies that examine the prevalence of
different types of trauma include measures for the experi-
ence of prejudice and discrimination based on age, gender,
and race/ethnicity.
The prior literature is plagued with differing definitions
of key variables, such as trauma, self-esteem, and PTSD.
Therefore, future research should incorporate more consis-
tent definitions of key variables. Future studies also should
more closely examine the psychometric properties of instru-
ments specifically to examine the validity of standard mea-
sures of trauma assessment, health, and mental for these
diverse populations of older adults, including indicators of
culture, such as acculturation.
The use of mixed-methods designs may help to uncover
the intervening mechanisms that prevent trauma or foster
resilience among trauma survivors in later life. Quantitative
studies should seek to include a nationally representative
sample with oversamples of minority populations. Global
comparisons of residents of different countries would help
yield information on trauma and its consequences. Qualitative
methods can help to unearth information to identify the fac-
tors that foster long-term resilience across the life course.
This information can be used to discern all of the factors that
comprise the mechanism that links earlier life trauma to later
life outcomes.
Study Limitations
There are a number of limitations to this current review that
warrant discussion. A critical limitation identified is the
sample size is N = 23. Although a comprehensive examina-
tion of online search engines and article reference lists were
conducted, it is quite possible that not every article that met
study criteria was included. Thus, a critical reexamination of
this area literature that includes more recently published
studies is warranted. The synthesis of the collective findings
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Maschi et al. 13
was based on studies that had their own methodological
limitations that included the use of nonexperimental and
cross-sectional designs, which limits making causal infer-
ences. Differing definitions of posttraumatic stress and other
variables used across studies also makes it difficult to com-
pare results. Another limitation worth addressing is the dif-
fering definitions of key variables (i.e., self-esteem, stress,
and most significantly posttraumatic stress).
Practice Implications
These collective findings help to inform prevention, assess-
ment, and intervention strategies. It is clear from these find-
ings that “an ounce of prevention is worth a pound of cure,”
particularly when examining childhood trauma and later life
implications. In cases where trauma is not preventable, early
life detection and treatment are important in reducing the life
cumulative effects of mental and physical health across the
life course. These findings also suggest that it is imperative
to make every effort to tackle not only the short- but also the
long-term influences of life-course traumatic experiences.
Currently, much of what is known about assessment and
treatment of trauma, especially related to PTSD treatment, is
based mostly on research and evaluation studies with sam-
ples of children and adults. However, the current research
findings using older adult samples provide some information
on how best to prepare helping professionals for accurate
and effective trauma and PTSD assessment and intervention
in working with older adults. Integrating palliative therapeu-
tic responses as prevention and remediation strategies will
also be helpful in reducing later life physical and mental
health consequences of trauma and enhancing older adults’
resilience. Based on the review of the literature, the follow-
ing recommendations for assessment and intervention are
outlined below.
Assessment. Useful trauma assessment measures for older
adults for specific kinds of trauma, such as combat exposure
are available (Cook & O’Donnell, 2005). Measures relevant for
assessing older adults included the Clinician-Administered
PTSD Scale (CAPS), the Structured Clinical Interview for
DSM-III (SCID), and the Mississippi PTSD Scale, all of
which have been found to have high internal validity with
combat veterans and other older adults populations with his-
tories of trauma (Blake et al., 2000; Hyer, Summers, Boyd,
Litaker, & Boudewyns, 1996; Neal et al., 1995). However,
the extent to which these measures are relevant for diverse
groups based on age, gender, and race/ethnicity remains
questionable (Bright & Bowland, 2008).
Helping professionals would best serve older adults if
they are competent in assessing the presence of recent devel-
opmental milestones or stressors among older adults along
with past and current trauma and stress, such as childhood
physical, sexual, and emotional abuse, financial abuse, and
neglect. Professionals also should be cognizant of the impor-
tant developmental milestones among older adults, such as
retirement, job loss, or widowhood, which may trigger psy-
chological distress or even PTSD symptoms (Hyer & Sohnle,
2001). As the literature suggests, an assessment of other
comorbid mental health problems, elder abuse, physical
health, and available social support is warranted (Krause,
2004).
Agencies and organizations that serve older adults, such
as medical clinics or nursing homes, would provide improved
service provision to older adult clientele by adopting agency
policies that include routine assessment for current and past
trauma and other stressful life events. Identifying valid mea-
sures based on the agency setting and the characteristics of
the older adult population served is critical. Depending on
the nature of intake and worker expertise of an agency set-
ting, structured interviews or rapid checklists could be used.
As revictimization (elder abuse) is correlated with past
trauma, having staff trained in current elder abuse assess-
ment is warranted (Cook & O’Donnell, 2005).
Screening for psychiatric symptoms, especially depres-
sion and anxiety, and physical functioning also would assist
in identifying other potential service needs and the need for
service linkages (Davies, 2003). Agency directors also
should provide training to prepare their staff for interdisci-
plinary collaboration because older adults’ diverse physical,
mental health, social, and social service (financial) needs are
distributed across different sectors of care.
Assessing for cultural trauma or stress is another impor-
tant concern. To meet the cultural diversity needs of agency
populations served, some trauma assessment measures might
have to be modified to include all types of past and current
trauma that also include cultural indicators, such as political
refugee status and forced relocations. In addition, older
adults’ level of acculturation may be a source of continuing
stress or conflict or a source of resilience. For example, the
cultural transition of Latinos has been recognized as having
implications for the mental and physical health outcomes of
immigrant adults (Alegria, Canino, Shroat, & Woo, 2008).
However, there is limited research that examines the influ-
ence of acculturation among ethnically diverse older adults
with histories of trauma or their experience of discrimination
as a child (e.g., school bullying) or adulthood (e.g., employ-
ment discrimination).
Intervention. There is limited evidence available about the
effectiveness of trauma treatment with ethnically diverse
populations of older adults. Some promising practices
include the Hyer and Sohnle (2001) PTSD treatment model.
This PTSD treatment model is implemented in stages in
which older adults’ acute mental health symptoms are first
treated followed by treatment strategies that build older
adults’ internal and external coping resources, especially the
reinforcement of social support.
Psychosocial prevention and intervention programs that
foster interpersonal resources, such as cognitive resources
and emotional and psychological resources, are warranted.
This type of programming might include activities such as
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14 Traumatology XX(X)
physical exercise, spirituality (e.g., meditation or yoga),
stress management, creative arts, and social support groups.
Cognitive-based interventions that target sense of meaning,
sense of safety, and self-esteem, including program compo-
nents and social support, may help foster resilience among
older adults. This type of multifaceted management of stress
and anxiety could assist with minimizing the reoccurrence of
stress related to recent events, such as the death of family
members or friends.
Programs that are culturally relevant should address
acculturation, age, race, and gender differences in the types
of trauma experienced and their response. The use of the arts,
such as group drumming, for a culturally sensitive stress-
reduction technique may be a promising nonverbal practice
and congruent with cultural practices (MacMillan, Maschi,
& Tseng, 2012; Maschi & Bradley, 2010).
Organizations serving older adults can engage in practice-
based research using agency case records, including effec-
tive treatments that fostered resilience among clientele. The
factors that foster resilience point in directions for factors
that should be addressed in the treatment. Agency records
may include information as to successes and failures in treat-
ment that might provide additional data to improve trauma
and stress management with older adults.
Palliative approaches to trauma prevention and intervention.
In addition to the life-course perspective discussed above,
consideration of person-in-environment ecological, public
health, and care ethics perspectives help to illuminate the
strengths of palliative care approaches to trauma prevention,
assessment, and intervention in older adults. Federal health
reform (Affordable Care Act, 2010) implementation is driving
rapid integration of primary care and mental health care.
Increasingly, the focus in health care delivery is person-
centered care, not the nature of one’s illness, diagnosis, or
treatment. The adoption of a person-centered approach in
palliative care is consistent with successful therapies for
trauma survivors (Maschi, Morgen, Zgoba, Courtney, &
Ristow, 2011).
In a palliative model of care, the patient and family are the
unit of care. Shared informed decision making is based on
identifying the patient’s goals of care, care planning, and
improving communication among the patient, family, and
members of the interdisciplinary team (Bomba, Morrissey,
& Leven, 2011; Fins, 2006). Early conversations with
patients, families, and their health professionals are aimed at
future care planning including planning that addresses both
health and mental health needs. The prevention and relief of
pain and suffering are also primary aims of palliative care. In
studies of illness, trauma has been found to be a dimension of
older adults’ lived experiences of pain and suffering
(Morrissey, 2011a, 2011b). Attunement to older adults’ social
ecological contexts, life-course histories, and social and devel-
opmental aspects of temporal experiences can inform pallia-
tive therapeutic responses to the aging person that target the
reduction and relief of trauma, pain, and suffering and strive to
enhance the quality of life (Morrissey, 2011a, 2011b).
Conclusion
In conclusion, the argument to take action on unraveling the
correlates and consequences of childhood trauma on later
life consequences is compelling. As these results suggest,
trauma is a diverse and global phenomenon with life-course
ramifications. The deleterious effects of trauma can be life-
course persistent and affect the well-being of individuals,
families, and communities. There are multiple points in the
life course to prevent or ameliorate interpersonal- and
community-level violence and stress by fostering the inter-
nal and external resources of those individuals, families,
and communities at risk. Future research can expand our
knowledge by conducting meta-analyses of trauma on spe-
cific mental or physical health variables, such as depres-
sion, PTSD, physical functioning, such as activities of daily
living, and subjective well-being. In addition, empirical
studies can test tenets of the theoretical model garnered
from this synthesis of the extant literature. In practice, help-
ing professionals, especially social workers, are well poised
to develop or refine trauma-informed psychosocial- and
community-level interventions that can prevent whenever
possible and assess and treat when needed. These efforts
will help provide the systemic social support that can help
foster lifetime resilience from childhood to older adulthood
for all persons.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
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... These adults suffered mental health and physical health symptoms, but the focus of their stories was not of pain and suffering, but of optimism that they are almost at their goal of having a better life. This supports the findings by Maschi et al. (2012), indicating that positive attitude or optimism, and social supports contribute to overcoming childhood trauma; social supports help buffer stress. ...
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