Effectiveness of treatments for post-traumatic stress disorder for older people: A systematic review and meta-analysis of randomized controlled trials

Background: Although effective treatments for post-traumatic stress-disorder (PTSD) in adults are well established, research reporting on the effectiveness of treatments for older people remains limited. Aims: To systematically review global evidence reporting on the effectiveness of treatments for PTSD in older adults. Method: We searched several databases for randomized controlled trials on PTSD in older people. Results: From a total of 17,987 search hits, 10 studies met our inclusion criteria; these reported on the effectiveness of narrative exposure therapy (4 trials), Cognitive Behavioural Therapy (2 trials), spiritual-focused psychotherapy (1 trial), life-review therapy (1 trial), collaborative care (1 trial), and physical activity (1 trial). We identified no trials evaluating the effectiveness of pharmacological interventions. Meta-analyses showed that trauma-based psychological treatments improved symptoms of depression (standardised mean difference (SMD) -0.48, 95 % Confidence Interval (CI) -0.74 to -0.23, 7 studies, 504 participants; moderate-certainty evidence) compared to treatment as usual at end of treatment. These interventions also reduced symptoms of PTSD post treatment but certainty of evidence for this outcome was low (SMD -0.29, 95 % CI -0.62 to 0.03, 5 studies, 261 participants). Conclusion: Trauma-based psychological treatments for older people with PTSD are better than treatment as usual in reducing symptoms of depression at post-treatment. These interventions may also reduce symptoms of PTSD, however the quality of evidence remains low. Future large-scale studies are needed to establish which interventions are more likely to be associated with the greatest benefits. Trials evaluating the effectiveness of pharmacological interventions for PTSD in older people are urgently needed.