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In nursing home residents with dementia, the pandemic may have triggered an exacerbation of past trauma, requiring awareness and informed care that is long overdue, say the authors of a new call to action.

The psychological impact of trauma can be lifelong and does not abate with age. And it can intensify with conditions such as dementia, Carole Estabrooks, Ph.D., of the University Alberta, Canada, wrote in an editorial published in JAMDA. Even for residents who have successfully managed past trauma, new stresses, such as nursing home admission, can reactivate PTSD or activate late-onset PTSD, she added.

PTSD affects an estimated 7% to 9% of people in the general population, and as many as 65% of residents in nursing homes that care for veterans and Holocaust survivors, the researchers noted. 

“We argue for a trauma-informed aged care perspective generally, and specifically for increased use of neurobiologically informed strategies in care homes to manage challenging behaviors associated with PTSD. The imperative is strong in the long shadows of COVID-19,” Estabrooks and colleagues wrote.

Not out of reach

Trauma-informed care practices are a regulatory requirement for skilled nursing facilities, but until recently, there were no models for this care and staff typically does not receive training in this area, according to Kelly A O’Malley, Ph.D., of Harvard Medical School and colleagues, who in May published a framework for implementing such care in the Gerontologist.

Yet compliance with this care is key to nursing facility survey success and quality care, according to the American Health Care Association / National Center for Assisted Living.

Although trauma-informed aged care is complex and will face implementation challenges, it is not beyond reach, Estabrooks and colleagues contended. They are calling for those who fund, administer and manage nursing facilities to address the issue by including the following in standards and regulations:

  • A trauma-informed framework and resources for elder care including evaluation activity;
  • Access to services such as mental health and social work for residents and staff that includes those with marginalized status;
  • Screening for new residents for past traumatic events while also considering that transition to a nursing home can restimulate or cause new trauma; and
  • Employee assistance programs developed in consultation with specific employee groups such as professional staff or the nursing assistant workforce, for example.

Standards and regulations also should require “measurable efforts” to provide strategies to care for residents who do not respond to initial strategies; help staff to better self-manage and prevent stress; and create positive work environments that broadly support quality of staff work life and well-being, they wrote.

Residents, families and direct care staff must be engaged in the planning and delivery of these actions, the researchers added. They also call for ongoing research to build evidence for trauma-informed interventions.

These recommendations require adequate staffing to meet basic resident needs. In the meantime, knowledge and principles of trauma-informed aged care should be incorporated into policy, practice and research, the authors said. “Action is long overdue, even in normal times,” they concluded.

Related articles:

Trauma-informed care in long-term care settings: from policy to practice

How to prepare for trauma-informed care

Managing transition-associated traumas: Making the move to long-term care a success

How to overcome the trauma of the pandemic in long-term care