Understanding PTSD in Older Adults

Before starting my private practice, I worked at the Veteran’s Affairs hospital for nearly a decade, and in the course of that work, I learned a great deal about treating PTSD (post-traumatic stress disorder) in older adults. We tend to associate PTSD with veterans or survivors of recent accidents. However, the reality is that many older adults carry the weight of past traumas, silently battling symptoms that can significantly impact their lives for many years.

Potential Long-Term Impacts of Untreated Trauma:

Traumatic events, by definition, are deeply disturbing and disruptive. They shatter our sense of security and leave a lasting impact on our psychological well-being. These events can happen at any age, and older adults may have a lifetime of experiences that could contribute to PTSD. Here are some common examples:

• Combat trauma: Veterans and survivors of historical conflicts, like the Vietnam War or World War II, may carry the emotional scars of combat for decades.

• Childhood abuse: Sadly, childhood abuse is a far too common occurrence. For older adults, the trauma of physical, emotional, or sexual abuse in their youth can resurface later in life, particularly during periods of transition like retirement or the loss of a spouse.

• Serious accidents: Accidents can leave not only physical scars but also deep emotional ones. Witnessing the sudden death of a loved one in a car crash or experiencing a life-threatening medical event can trigger PTSD symptoms.

• Witnessing violence: Exposure to violence, whether as a bystander in a crime or during a period of social unrest, can be deeply traumatizing. Older adults who lived through tumultuous historical periods like the civil rights movement or periods of political violence might be affected.

PTSD in Later Life:

The presentation of PTSD in older adults can differ from the classic symptoms often seen in younger populations. This can lead to misdiagnosis or delayed diagnosis, leaving individuals struggling without proper support. Here's what to watch for:

• Physical symptoms: Older adults with PTSD may experience a variety of physical complaints that seem unrelated to any medical condition. These can include fatigue, sleep problems, headaches, and stomachaches.

• Emotional changes: Irritability, anxiety, depression, and feelings of isolation are common signs of PTSD in older adults. They may withdraw from social activities, become easily frustrated, or lose interest in things they once enjoyed.

• Flashbacks or nightmares: Reliving the traumatic event through intrusive memories or vivid nightmares is another key symptom of PTSD. These can be particularly distressing for older adults, especially if they are triggered by seemingly innocuous things. In my experience, people with PTSD for many years may not have nightmares for quite some time, then have nightmares resurge after a time of significant stress, such as retirement or health changes.

• Avoidance behaviors: Avoidance is a way that many people with PTSD cope with trauma. Older adults with PTSD may avoid places, people, or situations that remind them of the trauma. Avoidance can occur for decades and really limit people’s lives. This can significantly limit their daily activities and social interactions.

• Difficulty concentrating or making decisions: The underlying stress of PTSD can affect cognitive function, making it difficult for older adults to focus, remember things, or make sound decisions. These symptoms can be mistaken for cognitive problems in older adults, but may be reversible with treatment. 

Why Recognition Matters:

Identification and intervention are crucial for managing PTSD in older adults. Here's why:

• Improved Quality of Life: Effective treatment of PTSD can significantly reduce symptoms like nightmares, hypervigilance, avoidance, anxiety, mood problems, and sleep problems. This can lead to a significant improvement in an older adult's overall well-being and quality of life.

• Reduced Risk of Other Conditions: Our minds and bodies are connected -- untreated PTSD can exacerbate existing medical conditions like heart disease, diabetes, and chronic pain. Additionally, the social isolation and emotional distress associated with PTSD can increase the risk of substance abuse disorders.

• Strengthens Coping Mechanisms: Therapy equips older adults with tools to manage stress, regulate emotions, and cope with difficult memories. These valuable skills can help them navigate challenges and build resilience.

Seeking Help:

If you suspect an older adult you know might be struggling with PTSD, here are some resources:

• Seek a therapist specializing in geriatric mental health: Geropsychologists like myself have specific training and experience working with older adults and understand the unique challenges they face, including the presentation of PTSD in this population.

• Consider support groups for older adults with PTSD: Connecting with others who share similar experiences can be a source of strength and validation for older adults with PTSD. Support groups can also provide valuable information and coping strategies.

• Consultation with a psychiatrist: There are geropsychiatrists who specialize in managing mental health conditions in older adults with medications. This can be very helpful in PTSD, and finding a psychiatrist with a specialty working with older adults ensures the safest and most tailored medication management. This is a great supplement to therapy for PTSD.

Start Working With a Therapist for Older Adults in LA

Remember, you're not alone. Many older adults experience PTSD, and effective treatments are available. With support and understanding, they can find healing, reclaim a sense of control, and live a fulfilling life. Dr. Reger can offer support and guidance from her Los Angeles, CA-based practice. Start the therapy process by following these simple steps:

1. Contact (424) 262-1925 to schedule your appointment

2. Meet with a Los Angeles Psychologist for an evaluation

3. Start addressing past pain!

Other Services Offered by Dr. Reger in Los Angeles, CA

Counseling for older adults isn’t the only service offered. In addition, I’m happy to offer support with a variety of assessments and testing. Other services offered include capacity assessments, neuropsychological and psychological assessments, and cognitive and dementia testing. Other services offered include pre-surgical assessments, and med-legal evaluations. In addition to evaluations, I also provide individual therapy, and mental health consultations and presentations. Visit my blog for more helpful support today!

California Conservatorships: Navigating the Maze with Capacity Testing

Today I wanted to delve into a complex legal and psychological issue in California: conservatorships and capacity testing. This topic often arises with aging loved ones, and navigating these decisions can feel overwhelming. But there is help and guidance available. I have worked with many families in Los Angeles to understand capacity and conservatorship from a psychological perspective, and have conducted capacity assessments in a wide variety of cases. Here’s how capacity testing can help ensure a fair and informed process if you or a loved one are navigating the possibility of a petition for conservatorship.

What is a Conservatorship?

A California conservatorship is a court-ordered legal arrangement where someone (the "conservator") is appointed to make decisions on behalf of another adult (the "conservatee") who is deemed unable to care for themselves or their finances. This can involve decisions about:

• Personal needs: Food, clothing, shelter, and medical care.

• Financial management: Paying bills, managing investments, making changes to a will or testament, and protecting assets from exploitation.

Why is Capacity Testing Important?

Capacity testing is a crucial component of the conservatorship process. It's a psychological evaluation that assesses an individual's ability to make informed decisions in specific areas. In the context of conservatorship, this typically focuses on two key domains:

1. Personal Needs Management: Can the individual safely manage their daily activities like preparing meals, dressing themselves, and taking medications?

2. Financial Management: Can the individual understand financial statements, avoid undue influence from others, and make sound financial decisions that are consistent with their values and well-being?

The Testing Process:

There's no single "capacity test." Evaluations involve a multi-pronged approach:

• Interviews: This involves gathering information from the individual, family members, and caregivers about their daily lives, decision-making processes, and any concerns.

• Cognitive Assessments: Standardized tests are used to assess memory, attention span, problem-solving skills, and judgment. These tests provide objective data about the individual's cognitive abilities. Just because someone has cognitive deficits or even dementia, does NOT mean they lack capacity. This information is crucial as part of a thorough evaluation, but it’s not the whole story. Many people with dementia maintain their capacity for decision-making, particularly if they have an established routine and support from family.

• Functional Assessments: Here, the psychologist observes the individual performing daily tasks related to finances and personal care, such as paying a bill. This may also involve asking test questions that get at a person’s comprehension and understanding of these tasks. For example, I may ask what someone would do in a hypothetical situation, such as if they accidentally cut their hand while alone at home, or ask them to explain a complex concept, such as health insurance. This helps determine their ability to function independently in real-world situations.

Importance of Capacity Testing in California:

• Accurate Information for the Court: Objective data from capacity testing helps judges make informed decisions about the necessity and extent of a conservatorship. It ensures the least restrictive option is considered to protect the individual's autonomy.

• Focus on Function, Not Diagnosis: California law emphasizes an individual's ability to function in daily life, not just a specific medical diagnosis. Capacity testing helps determine whether they can manage essential tasks independently.

• Protecting Well-Being: A conservatorship can be crucial if someone is vulnerable to financial exploitation, neglect, or self-harm due to impaired decision-making capacity. It provides a safety net until their abilities are restored or a less restrictive alternative is found.

California-Specific Considerations:

• Culturally Sensitive Evaluations: California recognizes the importance of cultural sensitivity in evaluations. Qualified psychologists consider the individual's cultural background, language, and values when conducting assessments.

• Least Restrictive Alternative: The court prioritizes options that allow the individual to retain as much autonomy as possible. A full conservatorship is only considered if less restrictive alternatives, like supported decision-making, are deemed insufficient.

Seeking Help:

If you're concerned about a loved one's ability to care for themselves or their finances, here are some resources to help you navigate the process:

• Consult with an attorney specializing in elder law or conservatorship. They can guide you through the legal aspects of conservatorship and the court process.

• Seek a licensed psychologist with experience in geriatric assessments and capacity testing, like Dr. Reger.  I can conduct a comprehensive evaluation and provide a report for your records, as well as complete any court forms, such as the GC-335 or a notarized declaration regarding capacity if those are needed and appropriate for your case.

• Contact your local Adult Protective Services agency for support and guidance. They can provide information on available resources and advocate for your loved one's well-being.

Remember: Conservatorship is a significant legal decision, and the process can be emotionally charged. Capacity testing ensures that decisions are made based on objective information, protecting the well-being of your loved one while respecting their autonomy to the greatest extent possible.

Let's Talk About a Capacity Assessment in Los Angeles, CA!

Have questions about California conservatorship, capacity testing, or resources for getting help? Feel free to reach out to Dr. Reger for support. You can learn more about the benefits of testing and more by following these simple steps:

1. Contact (424) 262-1925 to schedule your appointment

2. Meet with Dr. Reger for an evaluation

3. Start navigating the complexities of capacity assessments!

Other Services Offered By Dr. Reger in Los Angeles, CA

Capacity assessments are not the only service offered by my Redondo Beach-based practice. I know that you may encounter more than one mental health concern at a time. This is why I’m happy to offer multiple neuropsychological and psychological assessments. Other assessments include cognitive and dementia testing, pre-surgical assessments, and med-legal evaluations. In addition to evaluations, I also provide individual therapy, counseling for older adults, and mental health consultations and presentations. Visit my blog for more helpful support today!

Neuropsychological Assessments in California Workers' Compensation Cases – A Short Guide for Defense and Applicant Attorneys

As a defense or applicant attorney in California workers' compensation cases, you're likely familiar with the complexities surrounding head injuries, strokes, and other neurological issues that arise in the course of employment. Understanding the role and nuances of neuropsychological assessments can be crucial for building strong cases and advocating for your clients.

For Defense Attorneys:

Evaluating the Validity of Claims:

A neuropsychological assessment is often a valuable tool in evaluating the legitimacy of a claimant's cognitive complaints. The objective data obtained can identify inconsistencies between self-reported symptoms and test results, potentially revealing issues of exaggeration or malingering. Although there is no perfect way to assess for malingering of cognitive or emotional problems, well-validated tests designed to measure effort and performance validity are one of the best and most evidence-based options.

Assessing the Extent of Impairment:

While subjective reports of cognitive difficulties are present in many work injury cases, a neuropsychological assessment provides a more concrete picture of the functional limitations caused by the alleged injury. This information can be critical when determining the extent of disability and have a major impact when negotiating settlements.

Developing Return-to-Work Strategies:

Identifying the specific cognitive strengths and weaknesses of the claimant via neuropsych testing allows for the development of targeted recommendations for accommodations, work restrictions, and treatment to facilitate a safe and effective return to work. This can benefit both your client, by minimizing long-term disability, and the employer, by reducing lost productivity costs. And, as a bonus, this also helps the injured worker get back to work and move on with their life!

For Applicant Attorneys:

Building a Strong Case for Benefits:

A comprehensive neuropsychological assessment can significantly strengthen your client's claim for compensation by providing objective evidence of cognitive impairments directly linked to the work injury. This scientific data carries significant weight compared to solely relying on subjective complaints, and in cases where the neuroimaging doesn’t show structural changes (which is often the case in mild or moderate brain injuries), neuropsych testing can validate a person’s subjective report.

Maximizing Recovery:

Understanding the nature and severity of cognitive impairments helps develop tailored treatment plans and rehabilitation programs, aiming for optimal recovery and potential vocational retraining. This can significantly improve your client's long-term well-being and earning capacity.

Addressing Malingering Concerns:

A thorough neuropsychological assessment conducted by a reputable professional minimizes the risk of malingering accusations. The in-depth evaluation process and standardized testing protocols are designed to detect inconsistencies and ensure the assessment's validity.

Key Considerations for Both Sides:

Choosing the Right Expert:

Since neuropsych is not its own QME specialty, you will most likely need to seek out a clinical psychologist with specialty training in neuropsychological assessment as an Independent or Agreed Medical Evaluator. This can feel daunting, but here are a few tips.

This does not necessarily have to be a neuropsychologist, as long as the doctor has training and experience in neuropsychological assessment.

For example, I identify professionally as a clinical psychologist because I did not select an exclusively neuropsych training track when I got my doctorate and did my postdoctoral training. However, I did a great deal of psych and neuropsych assessment training throughout my education and fellowship in geropsychology (which requires expertise in neuropsych testing, among other things), including at highly regarded clinics like Cleveland Clinic, the UCSF Memory and Aging Center, and the San Francisco VA. I then went on to work in a rehabilitation/gero psychology setting, where I developed and directed the neuropsych assessment clinic in Spinal Cord Injury, and later directed the predoctoral psychology training program at the Long Beach VA. Now I run my own assessment and treatment practice.

As you can see, I have plenty of excellent training and experience with neuropsych assessment, but because I also do treatment, capacity assessment, and medical psychology, I don’t call myself a neuropsychologist; it is only one aspect of my work. So, let me be the example that broadening your search, from only self-proclaimed neuropsychologists to include clinical psychologists with experience and competence in neuropsych, might open up some doors in terms of finding an AME to do neuropsych evals in your cases.

Board certification is a great way for neuropsychologists to legitimize themselves in the field of neuropsychology.

However, board certification is not as emphasized or necessary in the field of psychology as it is in the medical field. According to the American Psychological Association, only about 4% of psychologists in the US are board certified, and I am confident there are many more than this who are highly trained, competent, and doing excellent work. Board certification is great, but it is only one marker of a high-quality psychologist.

Selecting a qualified and experienced psychologist with competence in neuropsych and workers' compensation cases is crucial. Look for professionals who adhere to best practices and have a track record of producing reliable and defensible reports; finding referrals by word of mouth is usually a good idea. A good psychologist doing neuropsych evals in work comp cases should approach from an objective lens and be honest about their findings, and in fact, this is an ethical obligation.

As psychologists, our job is not to support an attorney’s or injured worker’s opinions or desires; it’s to consider the data objectively and explain it honestly in a way that non-psychologists can understand. If an expert guarantees their findings will support your side of the case, they are overpromising and may not be credible under scrutiny!

Understanding the Assessment Process:

Both parties should have a basic understanding of the assessment process, including the types of tests administered, the information gathered, and the typical timeline for receiving the report.

Open Communication and Collaboration:

Open communication and collaboration between attorneys and the psychologist can ensure a smooth and efficient evaluation process, ultimately benefiting everyone involved by expediting resolutions and ensuring fair outcomes.

Start a neuropsychological evaluation in los angeles, ca

Neuropsychological assessments are not a perfect tool, but they can be valuable in navigating the complexities of workers' compensation cases that involve a neurologic injury with cognitive symptoms. Understanding their role and the nuances allows defense and applicant attorneys to effectively advocate for their clients and achieve fair and just outcomes. As a psychologist, I would be happy to offer support with a neuropsychological evaluation and other services. Start the evaluation process with Dr. Reger by following these simple steps:

1. Contact (424) 262-1925 to schedule your appointment

2. Meet with Dr. Reger for an evaluation

3. Get a better understanding of neurological issues!

Disclaimer: This blog post is intended for informational purposes only and should not be construed as legal or medical advice. Always consult with qualified legal and medical professionals regarding your specific situation.

Other Services Offered by Dr. Reger in Los Angeles, CA

Neuropsychological assessments aren’t the only service I offer. I know that you may encounter more than one mental health concern at a time. This is why I’m happy to offer multiple psychological assessments as well. Other assessments include capacity assessments, cognitive and dementia testing, pre-surgical assessments, and med-legal evaluations. In addition to evaluations, I also provide individual therapy, counseling for older adults, and mental health consultations and presentations. Visit my blog for more helpful support today!

Understanding Adult Psychodiagnostic Evaluations

If you've been struggling with mental health concerns that seem difficult to define, or if past treatments haven't yielded the results you'd hoped for, you might be a good candidate for a psychodiagnostic evaluation. People might find the idea of a psychodiagnostic evaluation (or even anything to do with a psychologist!) intimidating or mysterious, but this type of assessment provides a valuable opportunity to gain deeper insight into what may be driving your experiences and a path forward. I do psych evals with adults, and here is some information that you might find helpful if you’re considering an assessment.

What Exactly Is a Psychodiagnostic Evaluation?

Think of it as a comprehensive psychological detective mission focused on precisely understanding what's happening beneath the surface of how you think, feel, and behave. A psych eval goes beyond a few small questionnaires. In an adult psychodiagnostic eval, a skilled psychologist dives into:

• Deep-Dive Interview(s): I will get to know you through a thorough exploration of your personal history, current symptoms, and everyday experiences. In some cases, it’s also important to interview someone close to you, who can speak to what they have observed; this could be a parent, partner, caregiver, or close friend. Obviously, this type of additional interview is only with your consent.

• Testing and Measures: A carefully chosen battery of tests will shed light on your thought patterns, personality traits, and emotional states. This is tailored to your personal reasons for doing testing.

• Medical Records: Sometimes, though not in every case, I will want to look at past medical records relevant to the evaluation, for example, a cognitive assessment you did while in school for testing accommodations or records related to therapy, a brain injury, or a hospital stay.  

Why Seek a Psychodiagnostic Evaluation?

Several compelling reasons exist for seeking out a psychological evaluation:

Untangling Diagnostic Confusion:

Is it depression or bipolar disorder? Social anxiety or a posttraumatic stress disorder? A psychodiagnostic evaluation helps determine the accurate diagnosis (or diagnoses) even when the picture is complex. This is the number one reason I see adults for psych testing; they know something is going on and want to get a clear diagnosis.

Personalized Treatment Planning:

Diagnostic clarity and a deep understanding of your emotional and psychological landscape allow your psychologist to tailor a treatment plan to your needs. The right resources, education, therapy, medication (if appropriate), and support system become far more effective with a clear diagnosis.

Understanding and Validation:

In my experience, although it can be painful to get a psychological diagnosis, most people also feel a profound sense of relief when a diagnosis finally makes sense and validates their struggles. Understanding the nature of your mental health challenges is inherently empowering because it makes sense of things that have happened in your past and gives you a lens for understanding yourself. It can also help you give yourself some grace and compassion, rather than being hard on yourself for the ways you may be different from others in your life.

Identifying Strengths:

While focusing on challenges, a psychodiagnostic evaluation also illuminates your strengths and resilience. This creates a balanced, complete picture of who you are and the resources available to you in moving forward. 

What Happens During the Evaluation Process?

Although a psych eval will be tailored to your specific needs, most psychodiagnostic evaluations generally involve:

1. Initial Intake: You'll collaborate with your psychologist on understanding your concerns and goals, as we gather background information.

2. The Evaluation Itself: This typically spans several hours, or sometimes multiple sessions, and includes the interview(s), testing elements, and possibly observations.

3. Results and Feedback: I will carefully analyze the information gathered and share my findings. This includes clear explanations of the diagnosis, potential contributing factors, and your unique areas of strength. In my practice, I spend a great deal of time and energy scoring and interpreting the test results and writing up a comprehensive report for you. Although it’s many hours of work, this is helpful, because then you always have a record of that day – what your history was up to that point, your presenting concerns that day, your test results at that time, and my professional recommendations in black and white. The report gives you a reference to guide your treatment and lifestyle changes, and acts as a great baseline for comparison in the future.

4. Recommendations: As mentioned, in the report, you'll receive tailored treatment recommendations, which might include specific therapies, medication options, lifestyle adjustments, recommended readings or other tools for understanding your diagnosis, or resources for additional support, such as a referral for executive coaching or a support group.

Common Fears and Misconceptions

Feeling a bit nervous about this process is perfectly normal! Here's why you can relax:

• Judgment-Free Zone: I see evaluations as collaborative. I am not judging you but seeking to understand so I can help.

• It's Not About Labels: While precise diagnosis is valuable, a diagnostic label doesn't define you. This is only a tool for unlocking personalized support and self-understanding. I also believe that finally getting the correct diagnosis, sometimes after years of misdiagnosis or imprecise care, can allow you to move beyond the label in a way that being in the dark can’t.

• You're In Control: You participate every step of the way. You can ask questions, share what feels comfortable, take your time, and decline any tests you don't want to take.

Empowering Yourself: When to Consider an Evaluation

If any of these resonate, feel free to reach out to me about a psychodiagnostic evaluation:

• Previous treatments haven't produced the desired outcome.

• You suspect there's more going on than your current diagnosis suggests.

• You want a truly personalized plan for improved mental health.

• You long for a clearer understanding of yourself and your experiences.

• You have adopted negative beliefs about yourself as a result of mental health challenges, and these beliefs hold you back at your job, in relationships, or from personal growth.

A Journey Worth Taking

While it requires an investment of time, money, and effort, a psychodiagnostic evaluation often proves incredibly beneficial. Think of it as an investment in yourself – a chance to understand unanswered questions that hold you back and step into the clarity that allows healing and growth. As a psychological evaluator in Los Angeles, Dr. Reger would be honored to provide support in better understanding your mental health concerns. You can start the evaluation process by following these simple steps:

1. Contact (424) 262-1925 to schedule your appointment

2. Meet with Dr. Reger for an evaluation

3. Start addressing the mental health challenges affecting you most!

Other Services Offered by Dr. Reger in Los Angeles, CA

Psychological assessments aren’t the only service I offer. I know that you may encounter more than one mental health concern at a time. This is why I’m happy to offer multiple neuropsychological assessments. Other assessments include capacity assessments, cognitive and dementia testing, pre-surgical assessments, and med-legal evaluations. In addition to evaluations, I also provide individual therapy, counseling for older adults, and mental health consultations and presentations. Visit my blog for more helpful support today!