Co-occurring Posttraumatic Stress Disorder Symptoms and Dementia in Veterans Living in Long-Term Care

Abstract

Background: In older Veterans with dementia, Posttraumatic Stress Disorder (PTSD) can emerge, re-emerge, or worsen, resulting in negative consequences for Veterans and their families. Once admitted to long-term care (LTC), health care providers can misattribute symptoms associated with the co-occurrence of PTSD and dementia to the behavioural and psychological symptoms of dementia, and this can result in inappropriate interventions. The purpose of this research is to explore how the co-occurrence of PTSD symptoms and dementia is understood and identified in Veterans living in LTC. Methods: This dissertation consisted of three studies. The first study was a scoping review that examined how the relationship between PTSD and dementia in Veterans has been described in the literature. In study two, multiple case studies were conducted to understand co-occurring PTSD symptoms and dementia in Veterans in two LTC facilities in Canada. The third study used a qualitative descriptive approach to explore how health care providers in Canada have learned to identify co-occurring PTSD symptoms and dementia in Veterans. Results: PTSD and dementia in Veterans is an emerging area of research that is focused on understanding the etiology underlying the relationship, the symptomatic expression of PTSD and dementia, and the implications on health care providers, treatment, and resources. Case studies revealed that co-occurring PTSD symptoms and dementia are recognized as different than dementia alone, but these differences are highly nuanced and result in greater care challenges. Effective interventions are tailored to address specific symptoms. Moreover, health care providers recognize differences in co-occurring PTSD iii symptoms and dementia from dementia alone and tailor their care approach to specific symptoms, instead of using usual care strategies for dementia. Conclusion: The results of this dissertation contribute foundational information about co-occurring PTSD and dementia symptoms, highlight important identification issues, inform potential interventions and educational needs of health care providers, and inform future research to enhance the identification of co-occurring PTSD symptoms and dementia in Veterans.