Trauma, recovery and older people

Introduction

Over the past two decades, we have started to recognise and talk more about trauma. Research has explored its effects on vulnerable groups of people, and experts have developed and promoted principles of trauma-informed recovery. However, older people’s experiences of trauma and the application of trauma-informed approaches to their lives have been much less discussed.

This article draws on reflections by Gwenda Darling, an older woman living with dementia who has experienced multiple traumas. Gwenda explains what trauma is like for her:

To understand trauma, I think of my body like a box with a lid. Inside the box there are lots of balls bouncing around; they represent my thoughts and experiences. There is also a red button covering the wound caused by my trauma. The red button is my trauma trigger.

Sometimes one of the balls hits the red button and switches it on and the contents inside the ball explode everywhere. The trauma becomes everything, it pushes all else aside. It’s very painful.

That’s what triggering trauma is for me. When I go into trauma there are bits of thoughts and feelings and physical reactions everywhere. Sometimes in the explosion I see things I’ve never seen before. Sometimes the first explosion triggers other explosions. I become panicked, hypervigilant, and the feelings in my gut and heart are so intense.

When that happens, I need to check what ball or thought or experience has hit my red trauma button. I need to restore order inside the box. I need to let the wound heal again. To achieve that, I need space and compassion and I need to feel like I am heard, believed, validated and safe.

What is trauma?

• Trauma is an emotional response to a distressing event. The word ‘trauma’ comes from the Greek word for ‘wound’.

• Trauma can arise from experiencing war, dispossession, institutionalisation, natural disasters, accidents, assaults, abuse, violence, injury, illness, ageism or the death of someone we love.

• The longer we live, the more trauma we are likely to experience.

What does trauma look like?

The ways trauma is experienced are as diverse as people themselves. Some of the things people may experience include:

• distress

• emotional upset

• anxiety

• insomnia

• appetite disturbance

• fear

• sadness

• guilt

• flashbacks

• mistrust of others

• anger.

The extent of the harm is not dependent on the ‘degree’ of trauma, or what other people think about it; the harm is whatever you say it is.

For older people who have experienced trauma

If you are an older person, you may be more likely to have experienced complex trauma or repeated instances of one or multiple types of traumas. You may have experienced trauma multiple times through your life. But you might never have called what you’re experiencing ‘trauma’.

This isn't surprising, given that historically we weren’t ‘allowed’ to acknowledge trauma and there was little or nothing available to help us recover. We were often taught to ‘get on with’ life and to put aside our emotional responses, particularly if we were unable to leave the traumatic situation.

Why you may not have recognised your trauma

A few decades ago, for example, if you were a woman who experienced sexual abuse or violence by your husband in the early days of your marriage, you had very few options. There were no family violence or sexual assault services to support you, and marital rape immunity laws meant husbands could not be prosecuted for rape. Gender inequalities also made it difficult for you to survive financially if you left an abusive partner.

In contexts like this, you may have repressed your emotional responses to the trauma and moved on, experiencing little effect on your life. Alternatively, trauma may have shaped your future relationships, health and wellbeing in profound ways.

You may find the historical trauma resurfaces in old age, when you have space to reflect on what happened and find new language to describe your experiences.

Can you talk about the effects of trauma?

If you’re older, you may find it difficult to communicate the impacts of trauma. You may not be able to clearly link what you’re feeling to a traumatic event, particularly if it happened in your childhood or was repressed.

If you are unable to communicate, you may have no way to share the causes of your distress. You might share only fragments of a trauma story – with no beginning, middle or end – if you have cognitive or communication difficulties. This does not mean you have not experienced trauma.

Our bodies have memories. Being unable to communicate the impacts of trauma is not the same as being trauma-free. In fact, the difficulty you have in communicating what you feel may make the trauma worse, and your recovery may be more drawn out.

The trauma may also worsen if other people – your family, friends and service providers – fail to understand your trauma. This can even result in acute stress disorders or post-traumatic stress disorder (PTSD).

Communicating trauma can be difficult for people living with dementia, which sometimes fuels an incorrect belief that trauma is absent, insignificant or forgotten. However, in a 2006 report to the US Department of Justice, Professor Ann Burgess noted that in most cases, dementia doesn’t have a debilitating effect on the endocrine system or stress responses to trauma.1

In other words, people living with dementia do experience trauma.

For providers of services to older people

If you are a care or service provider for an older person, you are in a position to support their recovery from any trauma they may have experienced, even if you don’t know about the trauma.

Globally endorsed principles of trauma-informed practice should be built into any care or support provided to an older person.

The principles of trauma-informed care for older people

The five globally recognised principles of trauma-informed practice are:

• safety

• choice

• collaboration

• trustworthiness

• empowerment.

These principles are closely aligned with the Australian Government’s Aged Care Quality Standards:

• Standard 3: older people receive care that is safe and right for them

• Standard 5: older people feel safe

• Standard 6: older people are consulted to ensure they feel safe

• Standard 1: older people can make informed choices about their care and life

• Standard 2: older people are partners in ongoing assessment and planning

• Standard 4: older people get services/supports to do the things they want to do

• Standard 8: older people can partner in improving the delivery of care and services

• Standard 6: older people are encouraged and supported to give feedback

• Standard 8: older people can partner in improving the delivery of care and services

• Standard 5: older people feel they belong

• Standard 6: older people’s feedback/complaints result in appropriate action

• Standard 7: older people believe staff are knowledgeable, capable and caring

• Standard 8: older people feel confident the organisation is well run

• Standard 1: older people are treated with dignity and respect

• Standard 2: older people are partners in ongoing assessment and planning

• Standard 5: older people feel they belong

• Standard 6: older people feel encouraged and supported to give feedback

• Standard 8: older people feel confident the organisation is well run

It might seem more important to apply these principles and standards to services for older people immediately after a traumatic event happens. However, trauma-informed practices are fundamental for care service delivery every day.

Strategies for ensuring services are trauma-informed

If you are a carer or service provider, the following strategies are ways that you can support older people to recover from trauma. They could also prompt discussion about how the principles of trauma-informed services can be applied to each service that you provide.

1. Believe every older person who reports a traumatic event.

2. Ask the older person what they need to be safe and feel safe.

3. Understand that older people who report a recent traumatic event may be dealing with both historical and recent trauma at the same time.

4. Offer the older person access to appropriate support services, including counselling.

5. Offer access to sexual assault or family violence services if the older person reports sexual assault or family violence.

6. When offering support services, ask the older person if they’d like you to help them contact the services.

7. Find out what the older person wants and needs.

8. Give the older person choices and let them know they are in charge of what they decide to do.

9. Show compassion in your voice.

10. Practice sensitive care, communicate to the older person what you are doing, and check their permission before you do it.

11. Allow the older person time to process or make decisions about what they need.

12. Offer the older person the opportunity to have carers or service staff they are familiar and comfortable with.

13. Understand that changes in behaviours are an expression of what the older person is feeling – an unmet need.

14. Undertake education on trauma and older people, including:

    • the impacts of the repression of older people’s historical experiences

    • the impacts of trauma

    • the principles of trauma-informed services for older people

    • how to create safe spaces for older people to talk about their experiences

    • how to ensure support services are inclusive of older people.

15. Undertake education on trauma and people living with dementia, including:

    • the stress response

    • indicators of trauma, such as changes in behaviours

    • vulnerability to trauma associated with difficulty communicating and not being believed

    • strategies to support recovery.

Trauma-informed approaches to services for older people are evidence-based, compassionate and humanistic. You don’t have to be a trauma expert to be able to listen to older people; rather, what you need is to see older people as valued human beings with both a past and a future: with traumas and with the potential for recovery.

Recognise the extended effects of trauma

To provide truly trauma-informed care for older people, you also need to recognise the associated trauma for family, friends and service providers. The distress others may feel about the trauma experienced by older people can result in the older person minimising or denying their trauma and create other barriers to their recovery. Everyone in the older person’s circle can benefit from knowing they, too, are heard and supported.

Helplines

Compass has a directory of service providers available. Click here to access the listed helplines.

Disclaimer: The information provided on this website is not a substitute for individual health advice from a health professional.