Trauma-Informed Care for an Aging Population

 

Trauma-Informed Care for an Aging Population

By:  Tabatha Nute

The millions of trauma survivors in the world, whose bodies harbor deeply hidden secrets, unseen scars, and experiences, require a different healthcare provider approach. Their needs are unique in a way that traditional methods may fail to recognize.  For these individuals, providers who practice trauma-informed care create a culture that may feel safe and healing, potentially for the first time.

 Trauma is an emotional response to an adverse or disturbing event over which the survivor has no control (Bowen & Murshid, 2016).  Primarily, trauma is caused by nature (natural disasters) or humans (interpersonal).  Trauma is a boundless, destructive, and expensive issue of public health.  It occurs to people regardless of age, socioeconomic status, race, gender, sexual orientation, or religious background.  Nearly 70% of adults have experienced some form of trauma, though not all these experiences manifest into lifelong impairments (Simon & Loush, 2017).

The Adverse Childhood Experience study (ACEs) was first conducted in the 1990s as a joint venture between Kaiser Permanente and the Centers for Disease Control (CDC).  Seventeen thousand participants were mailed questionnaires asking if they experienced any one of ten-specific trauma-inducing events during their childhood.  These events ranged from witnessing violence to physical or sexual abuse.  The study results indicated that over 60% of adults had experienced one type of ACE.  Results also showed that people with four or more ACEs were more likely to develop mental health disorders, substance use disorders, and other chronic health issues (Centers for Disease Control, 2020).  Recent estimates regarding the cost of untreated substance use disorders, expenses related to child abuse and neglect, psychiatric and medical health issues, and lost productivity related to trauma are approximately $425 billion per year (National Council for Behavioral Health, 2020).  Trauma is common, costly, and primarily preventable.

Results from ACEs can be used to improve health care for all generations.  For the Greatest Generation, who have already crossed the threshold into old age, and Baby boomers, all of whom will have reached the milestone by the year 2030, the understanding of trauma can lead to better health comes.  These generations will have lived long enough to experience various personal or collective traumas.  Additionally, age-related traumas, such as retirement, declining health, and the frequent and unexpected loss of loved ones, can reduce natural support systems necessary for resilience (Ogle, Rubin, & Siegler, 2014).  As the world prepares to care for an historically significant number of elders, it will be essential to utilize a trauma-informed approach to create a safe and compassionate culture and avoid unnecessary re-traumatization. 

If organizations utilize a trauma-informed approach, some individuals with trauma histories will be more likely to seek medical attention to treat chronic and preventable medical health conditions.  The Substance Abuse and Mental Health Services Administration (SAMHSA) outlines four key assumptions and six core principles for the trauma-informed organization.  The four key assumptions are (1) the realization of the impact of trauma, (2) recognizing signs and symptoms of trauma and related illnesses, (3) the appropriate response to people with trauma, and (4) the resistance of re-traumatization for all consumers and employees.  The six core principles are safety, trustworthiness/transparency, peer support, collaboration/mutuality, empowerment and choice, and intersectionality.  This kind of care does not need to be performed by specialists (SAMHSA’s Trauma and Justice Strategic Initiative, 2014).  The purpose is not to heal hurts of the past (Purkey, Patel, & Phillips, 2018).  Instead, trauma-informed care creates and upholds a culture of safety and healing.

Recognizing that various life events shape our aging process will assist in better treatment for our aging population.  When implemented correctly, trauma-informed care can give power to the powerless and voice to the voiceless.  It refutes the question, "what's wrong with you?" and instead asks, "what has happened to you?”  Or "how can we work with your strengths?"  Trauma-informed care sets a standard of care that levels the playing field for everyone.

References

Bowen, E. A., & Murshid, N. S. (2016). Trauma-Informed Social Policy: A Conceptual Framework for Policy Analysis and Advocacy. American journal of public health, 106(2), 223–229. https://doi.org/10.2105/AJPH.2015.302970

Centers for Disease Control. (2020). Violence Prevention:  Preventing Adverse Childhood Experiences Retrieved from https://www.cdc.gov/violenceprevention/acestudy/fastfact.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fviolenceprevention%2Fchildabuseandneglect%2Faces%2Ffastfact.html

National Council for Behavioral Health. (2020). Trauma-informed, Resilience-oriented Care. Retrieved from https://www.thenationalcouncil.org/consulting-services/trauma-informed-resilience-oriented-care/

Ogle, C. M., Rubin, D. C., & Siegler, I. C. (2014). Cumulative exposure to traumatic events in older adults. Aging & Mental Health, 18(3), 316–325. https://doi.org/10.1080/13607863.2013.832730

Purkey, E., Patel, R., & Phillips, S. P. (2018). Trauma-informed Care: Better Care for Everyone. Canadian Family Physician Medecin de Famille Canadien, 64(3), 170–172.

SAMHSA’s Trauma and Justice Strategic Initiative. (2014). SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach. Retrieved from https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf

Simon, A. & Loush, M. (2017) Trauma-informed care: Implications for the Future.  Retrieved from https://www.michigan.gov/documents/lara/4._Trauma_Informed_Care_Presenation_554764_7.pdf

About the Author

With 15 years of health care experience and a background in therapeutic recreation and health care administration, Tab Nute works in Portland, Maine as a Program Coordinator at a residential treatment center for homeless adults with co-occurring disorders.  In addition, she is pursuing her MHA degree at St. Joseph’s College of Maine.  This blog post was adapted from her graduate “Gerontology” research.