What comes to mind when you hear the term “trauma”? For most people, you think about things such as PTSD, natural disasters, death of/serious injury to a loved one, victims of domestic violence, and now in the year 2020, we can all associate trauma with the ongoing global pandemic; not to mention the financial ruin many are experiencing due to the pandemic.
But what about trauma with the older adult population? How often do we, as a society think about that? More specifically, what about elder abuse and trauma? Worldwide, nearly one in six older adults experience some type of elder abuse in their lifetime.
In this blog I will attempt to enlighten you about the Trauma Informed Approach to Care with the elderly. I will touch on how traumatic events earlier in life, sometimes lead to trauma experienced later in life. I will discuss how seniors who are victims of elder abuse are traumatized by this, and the lasting effects elder abuse, neglect, and exploitation have on victimized older adults. But before getting into that, I will first tell you how I became aware of the Trauma Informed Approach.
The term Trauma Informed Approach to Care is rather new to me. I first remember becoming consciously aware of the term “Trauma Informed Approach” in June of 2017. I had just recently been promoted to a supervisory position with Older Adult Protective Services, the agency tasked with investigating elder abuse, and was attending a seminar in Butler, PA. The seminar was hosted by OVW, the Office on Violence Against Women, in collaboration with the Pennsylvania Departments of Health and Aging. The purpose of the seminar was to introduce the Trauma Informed Approach to the Adult and Older Adult Protective Services, as well as to increase collaboration between the domestic violence and protective services communities.
In retrospect, even though I only became consciously aware of the term Trauma Informed Approach in 2017, I have been using this method of care without realizing it since beginning my career in the social services going back to the mid-1990s.
When I first started my professional career at the Barber National Institute, many of the intellectually disabled men I worked with had been victims of terrible abuse and neglect from their pasts, during a time when many of them lived in institutionalized type settings. These men required a different approach; one with a knowledge and understanding of the past trauma they experienced. When I was a counselor at Harborcreek Youth Services, many of the boys who were in our care, were victims of unspeakable sexual abuse. They too required an understanding of their own victimization in order to begin understanding why they themselves would go on to victimize others. The few years I spent with Erie County Crisis Services, I routinely interviewed, assessed, and assisted individuals experiencing an acute crisis, often times associated with trauma from their own pasts. On a few occasions, while at Crisis Services, I was tasked with offering counseling to grieving family members whose loved one had successfully committed suicide, or had died in some other traumatic way. My point being, I was using the Trauma Informed Approach long before referring to it as such.
Since 2003, I’ve been working in the field of Older Adult Protective Services. It is Older Adult Protective Services job to investigate reported cases of elder abuse, neglect, exploitation, and abandonment. Just like in my previous professional vocations, I had been using the Trauma Informed Approach the entire time I have been working in OAPS, without referring to it as such. Since attending the seminar in Butler in 2017, we are training OAPS investigators on the Trauma Informed Approach, and how to implement it. Now I will say this approach is not for every case we investigate.
Sometimes another approach is called for, but in cases in which it has been reported that alleged victims have allegedly been subjected to domestic violence, including physical, sexual, and emotional abuse, we are going to initiate the investigation by using the Trauma Informed Approach with the alleged victim. As we have become more familiar and comfortable with using this method, we are now being called upon to spread the message to others. In the fall of 2019, myself and Amanda Merski, the Chief of Social Work at the Erie VA Medical Center, represented the Erie County Elder Justice Task Force at the Annual Trauma Conference held at Edinboro University. We presented a course at the conference entitled, “Trauma Through the Lens of an Older Adult”. Much of the material in this blog comes directly from that presentation.
Older adults experience the same types of trauma that all other age groups experience. They too are traumatized by sudden loss, death of a loved one, natural disasters, terrorism, global pandemics, etc. Unlike other age groups, older adults will sometimes experience longstanding effects from traumatic events that occurred earlier in their lives. These traumatic events may have never been properly addressed or treated when the older adults were younger. An older adult may have been exposed to some type of traumatic event such as military combat exposure, or maybe they were the victim of a sexual assault when they were young adults, and then they can be re-traumatized by these events in their senior years. This is especially prevalent with seniors who are suffering from some type of cognitive impairment, including dementia, mental illness, substance abuse, or a combination of the three. These individuals, whom often are not oriented to person, place, or time, can relive these same traumatic episodes over and over again.
Older adults can experience certain types of trauma that are usually associated with their age group, more so than other age groups. An example could be retirement, either forced or voluntary. Now many seniors look forward to their retirement and enjoy it when they reach that time in their lives. But sometimes when an older adult has to retire from their life’s work, they lose their sense of purpose, and for some this can be a very traumatic event that could potentially lead to both physical and cognitive impairment later in life. Ageism, or age discrimination, is another form of potential trauma that is unique to seniors. The loss of a spouse, while not exclusive to seniors, is a traumatic event that does effect seniors disproportionately. Social isolation is another concern among senior citizens that can lead to trauma. As seniors age, and lose their ability to function independently, there are times when they will become socially isolated, either self-imposed or imposed by another. This loss of regular human contact can be very traumatizing. In the era of sheltering in place, and isolating at home, I think we all now have a better understanding of how traumatizing isolation can be.
Specifically in regards to elder abuse and trauma, Older Adult Protective Services investigates for physical abuse, sexual abuse, emotional abuse, caregiver neglect, self-neglect, financial exploitation, medication diversion, and abandonment. Each and every one of these forms of elder abuse can be traumatic in their own way. Rarely is somebody a victim of only one of these types of abuse. Usually victims of elder abuse experience polyvictimization, meaning that they are victims of multiple types of abuse and neglect. Somebody who has been a victim of physical and/or sexual abuse may not experience trauma the same way in which somebody who is a victim of financial exploitation. Both are awfully traumatic, but the reactions to these different types of trauma will vary in each individual case.
Older adults are also more vulnerable than the general population. Often times, seniors are dependent upon others to assist them with their activities of daily living, making them more susceptible to becoming victims of abuse and neglect. When a senior is victimized, due to their age and frailty, they are less likely to recover, both physically and cognitively. The trauma caused by victimization may have a more significant and life changing effects, then if say the victim were younger. The victimization itself could potentially lead to the loss of independence and personal freedom. When an older adult loses their assets, there is less of a chance of them being able to recover these assets through the remainder of their lives, and often times leads to a drastic change in life style, as the senior no longer has the assets to live the rest of his or her life as they had planned to. These individuals are regularly left impoverished, severely limiting their choices moving forward.
Older adults who suffer ongoing, chronic abuse are under constant stress and anxiety that can contribute to chronic health concerns. Stress increases cortisol levels in people, which leads to increases in hypertension and cardiovascular disease, an inability to regulate inflammation, an inability to regulate glucose levels, and disturbance in sleep patterns. Unfortunately, trauma symptoms in older adults are frequently unrecognized and unreported. Many times physical and cognitive ailments are mistakenly attributed to “growing old”. Other times a senior may be diagnosed with a mental illness, specifically depression and anxiety disorders, the most commonly diagnosed mental illnesses among older adults.
Implementation of the Trauma Informed Approach with an older adult is basically the same approach one would use for the general population. Be aware of both verbal and non-verbal cues. Recognize that behaviors and resistance are not personal attacks, but exacerbation of the trauma. Take the necessary time to talk and listen to the older adult, while at the same time considering their individual needs. Give the older adult time to process and respond. Do not be in a hurry. Understand the implications that may be involved with disclosing a traumatic event. Respect boundaries, don’t pressure or force conversation. Support self-determination with the victim, while at the same time advocating and educating the victim. Embrace mutual learning between both the older adult and you, the professional. Lastly, increase cultural and age related competence prior to engaging with the older adult.
So you see older adults in many ways deal with trauma just like the rest of us do. They do however have their own unique circumstances that are associated mostly with people in their age group. Elder abuse is prevalent in our society and contributes to trauma senior citizens experience. I close in asking that we as a society do not forget about our seniors when dealing with the issues of trauma and the use of the Trauma Informed Approach.
Trauma Informed Dementia Care
MINNA’S STORY: DEMENTIA AND PTSD