It is estimated that 70-90% of Americans over the age of 65 have been exposed to at least one traumatic event in their lifetime. For a generation that endured major events such as The Great Depression and World War II, the potential for an older adult to have experienced trauma is great. The VA has found that both chronological age as well as the developmental processes of aging itself can have strong influence on the symptoms of PTSD.
Trauma can be seen as a risk factor for dementia due to an overproduction of glucocorticoids, or hormones produced in response to stress. They control functions such as sleep, behavior, cognition, memory, mood and affect—with overproduction of these hormones often leading to cell death and a much higher chance of developing some form of dementia.
Trauma is a personal experience and some people are not comfortable sharing those experiences with others. It’s important to note that a person does not require a PTSD diagnosis to be provided trauma-informed care. Though care providers will typically never be able to know definitively if a person’s behaviors or emotions are caused by symptoms of PTSD, dementia or a mix of both, trauma-informed care can and should be provided at all times.
The Trauma-Informed Care Implementation Resource Center defines trauma-informed care as shifting the focus from “What’s wrong with you?” to “What happened to you?” A trauma-informed approach to care acknowledges that health care organizations and care teams need to have a complete picture of a person’s life situation—past and present—in order to provide effective health care services with a healing orientation.
How to utilize a trauma-informed approach in dementia care
Below are steps that promote and uphold care that demonstrates respect for a resident’s life history prior to their life in our community:
- Life story work—It’s important to ask questions, allowing the individual and their family to share details about their life experiences that could be relevant when providing carte. The purpose is to gain insights into what type of trauma was experienced, which can help staff be more aware of certain triggers
- At CBV, we complete social history assessments for all new residents, focusing on their relationships and life experiences that have shaped the person they are now.
- If a resident or family is not comfortable providing specific details, ask general questions. If all you learn is that they have experienced trauma, it is enough information for us to provide general trauma-informed care responses, such as speaking in a soft tone, meeting someone at their eye level and avoiding addressing someone from behind
- Recognize common triggers—If the resident has experienced hunger, do not take their meal away abruptly; if they have experienced trauma related to war, avoid loud or startling noises. If they have endured a natural disaster, be aware of environmental cues such as temperature and weather
- Pay attention to factors such as light, noise, smell and other environmental triggers as they can all activate trauma memories. For example, if someone has experienced a near drowning accident, showers may be overwhelming. Staff at CBV consider alternate care methods, asking their loved ones how care was provided successfully at home
- Inversely, the environment can also be seen as a tool to support positive moods. CBV uses tools such as aroma diffusers, family photos, natural light and plants to promote a more home-like and comfortable environment, encouraging feelings of safety and familiarity
- Don’t take it personally—This can be difficult if a person becomes agitated or hostile
- Remind yourself that the resident is experiencing an emotional trigger and their brain is causing them to react instinctively, as if the event were occurring again
- If you feel overwhelmed, step away and ask for assistance. Your well-being is connected to their well-being because people with dementia often look to their caregivers for emotional cues
