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Robertson M, Colburn J, Gerber M. Applying a trauma-informed approach to home visits. J Am Geriatr Soc 2024; 72:1322-1328. [PMID: 38206878 DOI: 10.1111/jgs.18743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/22/2023] [Accepted: 10/03/2023] [Indexed: 01/13/2024]
Abstract
The concept of trauma and traumatic stress and its impact on health and mental health has been studied for nearly half a century. Trauma-informed care (TIC) is person-centered care designed and delivered based on knowledge of the ubiquity of trauma. It requires building an understanding of the role that trauma plays in the lives and health outcomes of survivors. In doing so, it helps promote physical, psychological, and emotional safety for both clinicians and patients. Trauma and traumatic events are cumulative over the lifespan, and individuals who have experienced trauma are at higher risk for re-traumatization and poorer health outcomes. TIC approaches have been applied in many healthcare settings successfully; however, to date, there have not been any recommendations made about applying these approaches to care of homebound older adults, even though it may be surmised that this population is at an especially high risk for prior trauma and entering a person's safe space could be especially sensitive for trauma survivors. This paper serves to provide specific recommendations for applying a trauma-informed approach to a home visit and provides recommendations to home-based primary care groups and health systems about implementing universal trauma-informed care to homebound older adults.
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Affiliation(s)
- Mariah Robertson
- Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jessica Colburn
- Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Megan Gerber
- Division of General Internal Medicine, Albany Medical College, Albany, New York, USA
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2
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Ruisch JE, Nederstigt AHM, van der Vorst A, Boersma SN, Vink MT, Hoeboer CM, Olff M, Sobczak S. Treatment of post-traumatic stress disorder in people with dementia: a structured literature review. Psychogeriatrics 2023; 23:523-534. [PMID: 36932467 DOI: 10.1111/psyg.12951] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/07/2023] [Accepted: 02/16/2023] [Indexed: 03/19/2023]
Abstract
Post-traumatic stress disorder (PTSD) is associated with cognitive dysfunctions and is an independent risk factor for dementia. A recent study has found the prevalence of PTSD in people with dementia is 4.7%-7.8%. However, little is known about the effectiveness of PTSD treatment for people with dementia. The primary aim of the current study is to review previous studies on the treatment of PTSD in people with dementia. A structured literature review was performed using a 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' analysis in PubMed, Embase, PsycINFO and CINAHL. Two independent researchers screened titles and abstracts. The inclusion criteria were: PTSD symptoms present, diagnosis of dementia, PTSD treatment form described and effects of the treatment mentioned. Articles that matched these criteria were included and content and quality were analyzed. We included nine articles, all case reports, with a total of 11 cases. The discussed treatment options are eye movement desensitisation and reprocessing (EMDR) (n = 3), prolonged exposure (n = 1), cognitive behavioural therapy (n = 1) and pharmacological treatment (n = 4). All articles reported a positive effect of the intervention on several monitored symptoms. Evidence for positive effects and feasibility of EMDR were most reliable, and it was applied in two articles of sufficient quality published in 2018 and 2019. EMDR 'on-the-spot' was described with positive effect in one article in which three cases were discussed. The quality of included papers ranged from insufficient to sufficient. This review shows that people with PTSD and dementia can benefit from PTSD treatment. EMDR, prolonged exposure, acceptance and commitment therapy and pharmacological treatment are applicable in this population. EMDR treatment is most described in this population (n = 5) and shows positive results, and the studies are of sufficient quality (n = 3). Further research in the form of a randomised controlled trial is required to study the effectivity of different treatment interventions in this population.
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Affiliation(s)
- J E Ruisch
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht, The Netherlands.,Department of Treatment and Guidance, Envida, Care for Elderly, Maastricht, The Netherlands
| | - A H M Nederstigt
- Department of Treatment and Guidance, Sevagram, Care for Elderly, Heerlen, The Netherlands.,VOSON, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A van der Vorst
- Department of Treatment and Guidance, Envida, Care for Elderly, Maastricht, The Netherlands
| | - S N Boersma
- VOSON, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M T Vink
- GERION, Department of Medicine for Older People, Amsterdam University Medical Centre/VUmc, Amsterdam, The Netherlands
| | - C M Hoeboer
- Department of Psychiatry, Amsterdam University Medical Centres Location AMC, Amsterdam Public Health, Amsterdam, The Netherlands
| | - M Olff
- Department of Psychiatry, Amsterdam University Medical Centres Location AMC, Amsterdam Public Health, Amsterdam, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - S Sobczak
- Mondriaan Mental Health Centre, Heerlen-Maastricht, The Netherlands.,Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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3
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Thorne TE, Titley HK, Duan Y, Norton PG, Lanius RA, Estabrooks CA. Care aides' perceptions of caring for residents with a history of psychological trauma in Western Canadian care homes. Int J Geriatr Psychiatry 2022; 37. [PMID: 36205024 DOI: 10.1002/gps.5818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/29/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore care aide perceptions of caring for residents who aides perceived had past psychological trauma. METHODS Through cognitive interviews, we developed a definition of trauma for four survey questions about caring for residents with psychological trauma. We added these questions to our routine care aide survey in 91 care homes in Western Canada (September 2019 to February 2020). We asked if care aides perceived that they were caring for residents with trauma, how often, types of trauma experienced, and what indication led them to perceive a resident had experienced trauma. We analyzed data using content analysis (open-ended questions) and regression analyses (closed-ended questions). RESULTS Three thousand seven hundred and sixty five care aides responded (70% response rate) to the survey, and 53% perceived caring for one or more residents with a history of psychological trauma in the previous 2 weeks. Within six categories of traumatic events, abuse (35%) and war exposure (26%) were most common. Most common indications of trauma reported by care aides (five categories) were reliving the experience or having intrusive symptoms (28%) and avoidant behaviors (24%). Care aides were more likely to report caring for a resident who they perceived had experienced past psychological trauma if they were younger, spoke English as their first language, self-reported experiencing more aggression from residents, or who worked in not-for-profit homes. CONCLUSIONS This preliminary study supports the need for further study of care aides' perceptions and experiences of caring for residents with past trauma, and the effects of caring for these residents on quality of work life.
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Affiliation(s)
- Trina E Thorne
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Heather K Titley
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Yinfei Duan
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Peter G Norton
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ruth A Lanius
- Department of Psychiatry & Department of Neuroscience, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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4
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de la Perrelle L, Klinge N, Windsor T, Low LF, Laver K, Cations M. Characterising trauma-informed aged care: An appreciative inquiry approach. Int J Geriatr Psychiatry 2022; 37. [PMID: 36017588 DOI: 10.1002/gps.5802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/12/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE While Trauma-informed care (TIC) has the potential to improve the quality of aged and dementia care, the challenge remains in translating the principles of TIC into practice. This study aimed to characterise what trauma-informed aged care looks like in practice, by learning from an aged care service acknowledged as delivering trauma-informed aged care effectively. METHOD We conducted an appreciative inquiry study within a residential aged care service catering for veterans and others with trauma histories. Observation of care behaviours, interviews with staff and residents, and organisational policy mapping were used to identify elements that maximised care safety and accessibility for trauma survivors. Data were analysed and triangulated using a framework analysis approach. RESULTS The aged care provider embedded the principles of TIC into its staff training (i) to promote understanding of how trauma may affect experiences in care, and (ii) to adapt care when appropriate to promote safety. The service promoted a calm atmosphere where residents could make choices and felt safe. Uniforms and signage provided consistency, clarity, and transparency for residents. Staff behaviours demonstrated respect, fostered trust, and anticipated needs without unnecessarily imposing care. Staff consistently offered choices, used residents' names, sought permission before providing care, and offered reassurance. Staff reported high morale with a commitment to delivering high quality care, and feedback to management. Effective communication promoted information sharing and trust among staff. CONCLUSION Trauma-informed practice was facilitated through organisational policy, a dignified environment, and thoughtful staff behaviour creating safety, choice, and control for residents.
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Affiliation(s)
- Lenore de la Perrelle
- College of Education, Psychology and Social Work, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Nathan Klinge
- RSL Care SA, Myrtle Bank, South Australia, Australia
| | - Tim Windsor
- College of Education, Psychology and Social Work, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Lee-Fay Low
- Sydney School of Health Sciences, Faculty of Medicine and Health, Sydney University, Sydney, New South Wales, Australia
| | - Kate Laver
- Department of Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
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5
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Cameron N, Fetherstonhaugh D, Rayner JA, McAuliffe L. Loss, Unresolved Trauma and Gaps in Staff Knowledge: A Qualitative Study on Older Adults Living in Residential Aged Care. Issues Ment Health Nurs 2022; 43:748-754. [PMID: 35235481 DOI: 10.1080/01612840.2022.2043496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Despite the prevalence of mental health concerns among those who live in residential aged care, many residential aged care facilities (RACFs) provide little by way of psychological support. Drawing on qualitative data obtained from interviews with residents from across 15 RACFs in Victoria, Australia, this article adds to understandings about the diversity and impact of mental health challenges experienced by residents, and gaps in the knowledge of staff about how to address such. Thus, it also offers evidence of the urgent need for RACFs to provide residents both better access to specialist mental health practitioners and training to care staff on mental health issues.
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Affiliation(s)
- Nadine Cameron
- Australian Centre for Evidence Based Aged Care, La Trobe University, Bundoora, Australia
| | | | - Jo-Anne Rayner
- Australian Centre for Evidence Based Aged Care, La Trobe University, Bundoora, Australia
| | - Linda McAuliffe
- Australian Centre for Evidence Based Aged Care, La Trobe University, Bundoora, Australia
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- Australian Centre for Evidence Based Aged Care, La Trobe University, Bundoora, Australia
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6
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Estabrooks CA, Titley HK, Thorne T, Banerjee S, Feldman HH, Silvius J, Lanius RA. A Matter for Life and Death: Managing Psychological Trauma in Care Homes. J Am Med Dir Assoc 2022; 23:1123-1126. [PMID: 35788266 DOI: 10.1016/j.jamda.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 02/02/2022] [Accepted: 02/14/2022] [Indexed: 10/17/2022]
Affiliation(s)
| | - Heather K Titley
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Trina Thorne
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Howard H Feldman
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - James Silvius
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ruth A Lanius
- Department of Psychiatry and Department of Neuroscience, Western University, London, Ontario, Canada
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7
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Kang B, Pan W, Karel MJ, Corazzini KN, McConnell ES. Care rejection and aggression among veterans with dementia with and without posttraumatic stress disorder: A multi-group analysis. Int J Nurs Stud 2022; 135:104330. [DOI: 10.1016/j.ijnurstu.2022.104330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/16/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022]
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Suskind AM, Vaittinen T, Gibson W, Hajebrahimi S, Ostaszkiewicz J, Davis N, Dickinson T, Spencer M, Wagg A. International Continence Society white paper on ethical considerations in older adults with urinary incontinence. Neurourol Urodyn 2021; 41:14-30. [PMID: 34558106 DOI: 10.1002/nau.24795] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 12/18/2022]
Abstract
Urinary incontinence is a common problem among older adults that is often complicated by many nuanced ethical considerations. Unfortunately, there is a lack of guidance for healthcare professionals on how to navigate such concerns. This International Continence Society white paper aims to provide healthcare professionals with an ethical framework to promote best care practices in the care of older adults with urinary incontinence.
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Affiliation(s)
- Anne M Suskind
- Department of Urology, University of California, San Francisco, California, USA
| | - Tiina Vaittinen
- Department of Social Sciences, Tampere University, Tampere, Finland
| | - William Gibson
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sakineh Hajebrahimi
- Departments of Urology and Family Medicine, Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Nina Davis
- Department of Urology, University of Oregon Health Sciences, Portland, Oregon, USA
| | - Tamara Dickinson
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Martha Spencer
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Adrian Wagg
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
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9
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Sobczak S, Olff M, Rutten B, Verhey F, Deckers K. Comorbidity rates of Posttraumatic Stress Disorder in dementia: a systematic literature review. Eur J Psychotraumatol 2021; 12:1883923. [PMID: 33968318 PMCID: PMC8075086 DOI: 10.1080/20008198.2021.1883923] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background: Post Traumatic Stress Disorder (PTSD) has been described as an independent risk factor for cognitive decline and dementia. At the same time, cognitive deterioration and increased loss experiences in dementia may increase liability for the reactivation of traumatic memories and thereby PTSD symptoms. Objective: In order to investigate co-occurrence of PTSD in dementia this systematic literature review summarizes all the available evidence on reported comorbidity rates of PTSD in patients with dementia. Method: PubMed, Embase, PsycINFO and CINAHL were searched for potential publications investigating the co-occurrence of PTSD in dementia until 25 November 2019. Cohort and cross-sectional studies were included. To assure current comorbidity of PTSD in dementia, only publications with a recent PTSD diagnosis (<2 years before onset of dementia) were selected. Results: Of the 860 identified abstracts, three studies (0.35%) met the eligibility criteria and were included. These three studies concerned only military veteran populations, and they comprised two cross-sectional cohort studies and one prospective cohort study. The estimated comorbidity rate of PTSD in veterans with dementia varied between 4.7% and 7.8%. Conclusions: The limited research available shows comorbidity rates only in military veterans, which were possibly dependent on investigated population with respect to dementia severity and possibly associated behavioural and psychiatric symptoms of dementia (BPSD). In dementia patients the comorbidity with PTSD may be high and we suggest that worldwide the impact of PTSD in dementia is high and probably underestimated. Research and care on this topic should improve urgently with the current expanding prevalence of dementia. A first step to improve quality of dementia research and care would be to develop a structured tool to diagnose PTSD in these patients.
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Affiliation(s)
- Sjacko Sobczak
- School for Mental Health and Neuroscience (MHeNs), Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Alzheimer Centrum Limburg, Maastricht, The Netherlands.,Department of Old Age Psychiatry, Mondriaan Hospital, Heerlen, Maastricht, The Netherlands
| | - Miranda Olff
- Arq Psychotrauma Research, AMC/University of Amsterdam, Amterdam
| | - Bart Rutten
- School for Mental Health and Neuroscience (MHeNs), Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Frans Verhey
- School for Mental Health and Neuroscience (MHeNs), Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Alzheimer Centrum Limburg, Maastricht, The Netherlands
| | - Kay Deckers
- School for Mental Health and Neuroscience (MHeNs), Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Alzheimer Centrum Limburg, Maastricht, The Netherlands
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10
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Van Assche L, Van de Ven L, Vandenbulcke M, Luyten P. Ghosts from the past? The association between childhood interpersonal trauma, attachment and anxiety and depression in late life. Aging Ment Health 2020; 24:898-905. [PMID: 30739477 DOI: 10.1080/13607863.2019.1571017] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives: Research suggests that vulnerability for anxiety and depression in late life results from a complex interaction between (neuro)biological and environmental factors. In this context, there is growing evidence for the role of childhood trauma on vulnerability for both anxiety and depression throughout the course of life, mainly through its effects on attachment as a biologically based neurodevelopmental stress regulation system. Yet, the impact of childhood trauma on depression and anxiety in late life specifically remains unclear. The current study therefore aims to investigate the association between retrospectively reported childhood interpersonal trauma, attachment dimensions and levels of anxiety and depression in late life.Method: A sample of 81 community dwelling older adults completed measures of early and current adversity, attachment dimensions, and levels of anxiety and depression.Results: The occurrence and frequency of childhood trauma, but not later negative adult life events, was associated with late life anxiety and depression. Both attachment anxiety and avoidance were related to anxiety and depression. Only attachment anxiety affected the association between childhood trauma, and emotional neglect in particular, and late life anxiety and depression.Conclusion: Childhood trauma may be associated with anxiety and depression in late life. Part of this association is probably indirect, via the effect of insecure attachment and high levels of attachment anxiety in particular.
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Affiliation(s)
- Lies Van Assche
- Section of Geriatric Psychiatry, Department of Psychiatry, University Hospitals Leuven, KUL, Belgium
| | - Luc Van de Ven
- Section of Geriatric Psychiatry, Department of Psychiatry, University Hospitals Leuven, KUL, Belgium
| | - Mathieu Vandenbulcke
- Section of Geriatric Psychiatry, Department of Psychiatry, University Hospitals Leuven, KUL, Belgium
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.,Research Department of Clinical Educational and Health Psychology, University College London, London, UK
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11
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Cations M, Laver KE, Walker R, Smyth A, Fernandez E, Corlis M. The case for trauma-informed aged care. Int J Geriatr Psychiatry 2020; 35:425-429. [PMID: 31840328 DOI: 10.1002/gps.5247] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 12/07/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Monica Cations
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Kate E Laver
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Ruth Walker
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | | | | | - Megan Corlis
- Helping Hand Aged Care, North Adelaide, South Australia, Australia
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Abstract
AbstractThe extant literature on Jewish Holocaust survivors’ experiences of receiving aged care services typically focuses on the risk that formal care settings may reactivate traumatic memories. Absent from previous research have been the viewpoints of older survivors themselves regarding their aged care experiences. An interpretive phenomenological approach was used to investigate Jewish Holocaust survivors’ lived experience of using community aged care services. Thirteen in-depth interviews were conducted and analysed using thematic analysis. The credibility of the findings was ensured by methodological triangulation and peer debriefing. Four major themes emerged from the analysis: wanting carers to do their job well; being supported to maintain autonomy; having a good relationship with the carer; and being understood as an individual. Although Holocaust survivors described the lived experience of using community aged care services in terms of universal themes similar to those identified with other groups of care recipients, the data revealed that this experience is intertwined with individual earlier-life traumatic experiences. This study has implications for training age care staff who work with Holocaust survivors and older trauma survivors from other refugee backgrounds.
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13
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Miller VJ, Hamler T. A value-critical policy analysis of the nursing home reform act: a focus on care of African American and Latino residents. SOCIAL WORK IN HEALTH CARE 2019; 58:471-493. [PMID: 30920360 DOI: 10.1080/00981389.2019.1587660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 01/25/2019] [Accepted: 02/22/2019] [Indexed: 06/09/2023]
Abstract
Improving nursing home care has been a central legislative focus since the 1980s; The major response effort to address these reports of poor-quality care was first met with a federal rule in 1987, the Nursing Home Reform Act (NHRA). Since enactment of the NHRA in 1987, and despite an increasing utilization of nursing home care by aging minorities, the standardization of care practice, or quality indicators (e.g., structural, process, and outcome measures), within long-term nursing home care have remained relatively unchanged. This paper reports a value-critical policy analysis of the most recent final action rule, effective on November 28 of 2016 by the Centers for Medicare and Medicaid Services (CMS) with a particular focus on its impact on African-American and Latino older adults. This paper presents results of two policy analyses. Taken together, this merged analysis focuses on an overview of the problem, the groups most affected by the problem, current program goals and objectives, forms of benefits and services, and a current state of the social problem. Following the analysis, we present changes and improvements to be made, as well as proposals for reform and recommendations for policy changes.
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Affiliation(s)
- Vivian J Miller
- a School of Social Work , The University of Texas at Arlington , Arlington , Texas , USA
| | - Tyrone Hamler
- b Mandel School of Applied Social Sciences , Case Western Reserve University , Cleveland , Ohio , USA
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14
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Gielkens E, Vink M, Sobczak S, Rosowsky E, Van Alphen B. EMDR in Older Adults With Posttraumatic Stress Disorder. JOURNAL OF EMDR PRACTICE AND RESEARCH 2018. [DOI: 10.1891/1933-3196.12.3.132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recognition of posttraumatic stress disorder (PTSD) in older adults is often difficult due to its complicated presentation. Once recognized, trauma symptoms can, in accordance with (inter)national guidelines, be successfully treated with eye movement desensitization and reprocessing (EMDR) therapy. However, limited empirical research has been done on the expression and treatment of PTSD in older adults. This article explains trauma and age in the context of psychotherapy. It discusses the interaction between age and pathology and summarizes the cognitive issues related to age, PTSD, and anxiety. It provides practical suggestions for how these can be addressed in treatment. Age-related challenges related to motivation are identified with practical suggestions for addressing them. The case illustrates the necessary additions and subtractions for older adults, with clear explanations and instructions. This article points the way for future research.
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15
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Ostaszkiewicz J. A conceptual model of the risk of elder abuse posed by incontinence and care dependence. Int J Older People Nurs 2017; 13:e12182. [PMID: 29218819 DOI: 10.1111/opn.12182] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 10/30/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To describe and critically analyse the thinking that led to the concept of an association between incontinence, care dependence and elder abuse. BACKGROUND Coercive or abusive continence care practices include chastising a person for their incontinence and overriding their attempts to resist continence care. Neglect in continence care is characterised by withholding or delaying responding to requests for help to maintain continence or to manage incontinence, and restricting a person's access to toileting assistance, incontinence aids or hygiene care. METHODS Contemporary biomedical understandings about incontinence and influencing concepts from the fields of sociology, psychology and nursing were analysed to inform the design of a conceptual model that elucidates possible associations between incontinence, care dependence and elder abuse. RESULTS Ideas generated from an analysis of the concepts led to the development of a model termed the "Model of Attributes to Abuse of Dependent Elders in Continence Care" (MADE-CC). The MADE-CC theorises factors that cause and contribute to abuse in continence care. Carer factors include physical and emotional exhaustion, frustration related to the inability to control or predict incontinence, resentment associated with constraints imposed by care dependence, disgust associated with physical contact with urine/faeces, limited knowledge and skills about incontinence and ethical conflicts concerning care. Care recipient factors include frequent and severe incontinence, cognitive impairment and a history of physical or psychological trauma. Social factors that are theorised include the stigmatised nature of incontinence, social taboos and cultural norms and the private nature of continence care. CONCLUSIONS The MADE-CC illuminates the potential risk of elder abuse posed by incontinence and care dependence. It should be used to improve ethical care of older people and stimulate debate about everyday ethics in the care of older people who are care dependent and to optimise their participation in decisions about their health and well-being. IMPLICATIONS FOR PRACTICE Nurses and carers should be aware of the multiple interrelated factors that contribute to the risk of elder abuse in the caregiving encounter, including the role of emotions.
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Affiliation(s)
- Joan Ostaszkiewicz
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Geelong, Vic., Australia.,National Ageing Research Institute, Parkville, Vic., Australia
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16
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Teshuva K, Borowski A, Wells Y. The Lived Experience of Providing Care and Support Services for Holocaust Survivors in Australia. QUALITATIVE HEALTH RESEARCH 2017; 27:1104-1114. [PMID: 27634292 DOI: 10.1177/1049732316667702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Lack of awareness among paid carers of the possible late-life consequences of early-life periods of extreme and prolonged traumatization may have negative impacts on the experiences of trauma survivors in receiving care. An interpretive phenomenological approach was used to investigate the lived experience of paid carers in providing care for Jewish Holocaust survivors. In total, 70 carers participated in 10 focus group discussions. Credibility of the findings was ensured by methodological triangulation and peer debriefing. Three major themes emerged: (a) knowing about survivors' past helps me make sense of who they are, (b) the trauma adds an extra dimension to caregiving, and (c) caring for survivors has an emotional impact. Specific knowledge, attitudes, and skills for building positive care relationships with Holocaust survivors were identified. The findings offer a starting point for advancing knowledge about the care of older survivors from other refugee backgrounds.
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Teshuva K, Wells Y. Aged care managers' perceptions of staff preparedness for caring for older survivors of genocide and mass trauma in Australia: How prepared are aged care workers? Australas J Ageing 2016; 36:E20-E22. [DOI: 10.1111/ajag.12286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Karen Teshuva
- Australian Institute for Primary Care and Ageing; La Trobe University; Melbourne Victoria Australia
| | - Yvonne Wells
- Australian Institute for Primary Care and Ageing; La Trobe University; Melbourne Victoria Australia
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Johnson KG, Rosen J. Re-emergence of posttraumatic stress disorder nightmares with nursing home admission: treatment with prazosin. J Am Med Dir Assoc 2012; 14:130-1. [PMID: 23141208 DOI: 10.1016/j.jamda.2012.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 10/11/2012] [Indexed: 11/18/2022]
Abstract
Seniors with a history of emotional trauma decades earlier can experience a recurrence of posttraumatic stress disorder symptoms when transitioning to a nursing home. We present the case of an 86-year-old male Holocaust survivor admitted to a nursing home for physical therapy and rehabilitation 6 weeks after the death of his wife; the patient was expressing a persistent death wish. Despite the multiple risk factors for depression, his distress was specifically related to the reemergence of nightly posttraumatic nightmares. Over the course of 1 week of treatment with 1 mg prazosin at bedtime, his nightmares and his death wish completely resolved. He achieved his rehabilitation goals and was discharged to a community setting. This report highlights the importance of considering posttraumatic stress disorder in nursing home residents with a history of emotional trauma, and understanding how to address these symptoms pharmacologically and nonpharmacologically.
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Affiliation(s)
- Kim G Johnson
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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