Trauma in older adults Tier 2 What is

Trauma in older adults Tier 2

What is trauma? • Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual wellbeing.

Trauma in older adults • Trauma is under-recognised • Trauma is under-treated • Older adults may fail to report or minimize traumatic experiences

Four Rs of a trauma focussed approach • Realisation that trauma can affect older adults • Recognition of the signs of trauma • Responding to the trauma so that the person feels safe physically, psychologically and emotionally • Resisting re-traumatisation by understanding the triggers for the memories and preventing them • Remember the goal is not for the older adult to disclose any or all details but rather to feel safe, develop trust and ultimately become improve their functioning

Realisation that trauma can affect older adults • Up to 90% of older adults have experienced at least one traumatic event in their lifetime • Examples include evacuation in the war, the unexpected death of someone close, serious illness or serious injury to self etc. • As a result of the previous trauma the person can find that situations that occur in everyday life may trigger memories of the trauma and affect the person’s responses • If you are unable to ascertain that there is a history of trauma the best approach is to assume there is

Triggers to traumatic memories Possible triggers to traumatic memories could be • A particular date – anniversary of a traumatic bereavement • A rigid regime with in a care setting – reminding them of being in a prison camp • A particular place/noise – reminding them of past physical abuse

Recognition of past trauma Possible symptoms of past trauma include • Intrusive distressing recollections/thoughts • Recurrent distressing dreams • Irritability and sleep disturbance • Flashbacks in which it can feel like the event is reoccurring • Distress when exposed to “triggers” symbolizing or resembling the trauma • Intense physiological reaction to trauma triggers • Avoidance of activities/places which provoke thoughts/feelings about the trauma • Negative beliefs and expectations

Responding if trauma is mentioned • It is appropriate to express your care and concern: “I am sorry that this happened to you. ” • You will need to allow the person extra time so you can listen to them • Validate the response: “That must have been very frightening”. • Normalise the response: “You are not alone”, “I know that this happened to others” but don’t minimize the trauma • You should not respond by questioning the person and asking “did that really happen? ” • It is often inappropriate to probe the person for details at this point

Resisting re-traumatisation • Ensure that if this trauma is new information to your care team that it is reported. • Assess and then care plan with the aim to reduce or prevent retraumatization by understanding the triggers for the traumatic memories and preventing them.

Guiding principles to prevent retraumatization • Create a physically and emotionally safe environment • Establish trust • Support autonomy and choice • Create collaborative relationships and participation opportunities • Use a strengths and empowerment-focused perspective to promote resilience and reduce re-traumatization and promote healing

Overview of techniques to intervene and treat trauma in older adults Techniques include • Psychological First Aid • Developing skills for Psychological Recovery • Trauma-focused Cognitive Behavioural Therapy • Exposure therapy – EMDR (eye movement desensitisation and reprocessing), life review and narrative

Resources • MPC_08_01 - Post Traumatic Stress Disorder And Other Traumas | Effects of Trauma (mindedforfamilies. org. uk) • This is an easy to access website for older adults and their families which has good advice about what trauma is , the effect of trauma , post traumatic stress disorder and practical suggestions of things that could help for family and friends