Vicarious trauma and working with older people

Sometimes I feel overwhelmed by the gap between the way the world is for older people and the way it needs to be. Over the past 40 years as a nurse, an aged care manager, an academic and an advocate, I have listened to hundreds of stories of disrespect, abuse, violence and sexual assault.

In response to each story I do what I can to make a difference, but sometimes it gets under my skin. Sometimes I feel sad, angry, anxious, overwhelmed, and I have trouble sleeping.

I now recognise these responses as vicarious trauma – or the trauma I feel working with older people who are experiencing distressing incidents. This vicarious trauma is made worse by the context, or knowing I am living a world that doesn’t care about older people enough.

There is growing recognition of the need to take trauma-informed approaches to working with older people. We have begun to focus on the healing and recovery of older people who experience trauma, as seen in the Trauma, recovery and older people Compass article on the effects of trauma on older people and the Older Persons Advocacy Network (OPAN)’s ‘Ready to Listen’ training for aged care professionals. But what about trauma-informed care for those of us working with older people?

Vicarious trauma happens when a person is exposed to and engages in some way with another person’s traumatic experience. It can be experienced by service providers working with older people who are survivors of incidents of neglect, assault, abuse, violence and other upsetting events. In this context, vicarious trauma can have multiple layers, which makes it harder to deal with.

Layers of trauma

Bearing witness to the suffering of older people is difficult for compassionate service providers. This difficulty may be made worse by our own internalised ageism or fears of our vulnerability and mortality. In working with vulnerable older people, we may catch glimpses of a future for ourselves that we want to avoid, and this may be confronting.

A further layer of trauma may be our recognition that as much as we want to meet the care needs of the older person, we may be thwarted by service gaps, abusive families and an ageist world. We want to make it better for our clients – and sometimes we can’t.

This can be particularly frustrating in care settings where workers who are committed to delivering high quality care are not supported by their colleagues or organisation.

Vicarious trauma can also be compounded because of our own personal histories of trauma. Many people have experienced trauma at some point in their lives: family violence, assault, an accident, a natural disaster, being a refugee, being bullied, or many other damaging experiences.

We carry these traumas around with us, and when we encounter new traumas, they may ‘trigger’ or remind us of our old ones. This can be emotionally painful for care workers and contribute to strong responses when we witness the trauma experienced by older people.

The effects of vicarious trauma on workers

These layers of difficulty can lead to psychological distress – including emotional upset, increased anxiety, sleep and appetite disturbance, fear, sadness, guilt or anger. For many professional care workers, these symptoms diminish in time; for others, they persist and can develop into acute stress disorders or post-traumatic stress disorder.

My experience is not an isolated one. I have lots of wonderful colleagues working with older people who tell me they also feel overwhelm and vicarious trauma. The good news is that understanding vicarious trauma can help us to improve services and empower us to take better care of ourselves – so that we can continue doing the important work we do.

In our ageist world, where older people encounter so much trauma, we need to support those who work with older people to manage their vicarious trauma. Without this support there is a significant risk of ‘cognitive dissonance’: workers denying or playing down what older people experience because they feel unable to help the older person or deal with the full weight of acknowledging what is occurring.

This is one of the many reasons to apply trauma-informed principles to care provision for older people.

What are the trauma-informed principles?

The principles of trauma-informed practice aim to create safe spaces by recognising the effects of trauma, preventing re-traumatisation and promoting recovery. The universal principles are:

• safety

• choice

• collaboration

• trustworthiness

• empowerment

Service organisations can adapt these principles to support their staff who work with older people. For example:

Safety

• Regularly meet workers to promote open communication.

• Regularly ask workers if they have any issues and concerns.

• Ask workers how they are feeling, validate their feelings, check their support needs and engage them in being part of the changes needed.

• Facilitate urgent meetings after incidents to check worker wellbeing.

• Ask workers for suggestions to improve safety.

Collaboration

• Communicate with workers to identify what supports they need.

• Check workers ideas for evaluating and improving services.

Choice

• Provide workers with options for debriefing following incidents.

• Provide professional support options to workers.

Trustworthiness

• Be responsive to worker concerns and suggestions by making appropriate changes or, when change is not possible, feeding back why.

• Document a ‘trauma-informed practice’ policy for workers and link it to the service’s quality systems.

Empowerment

• Provide education for all workers on trauma-informed practice.

• Provide guidelines for trauma-informed practice in incident management.

• Encourage workers to check in on each other every day.

These suggestions are only starting points for conversations about how to implement trauma-informed principles in care provision workplaces. Services could promote organisational culture change by facilitating team meetings to discuss workers’ ideas for each of the principles and develop workplace guidelines on trauma-informed practice.

The benefits of trauma-informed practice

The benefits of applying trauma-informed principles to services for older people are significant.

Benefits for care workers include:

• having safer workplaces

• feeling valued by the organisation

• feeling empowered to deliver the best possible care and services.

Benefits for older people include:

• trauma-informed care by workers who are supported in their own trauma

• improved healing and recovery from trauma

• better continuity of care through retention of workers who feel valued.

Benefits for organisations include:

• a safer workplace for workers

• a reduction in sick leave absences

• improved job satisfaction for workers

• greater staff retention through workers feeling valued

• improved recruitment of valued workers. 

• respect

These benefits depend on the organisation or service adopting trauma-informed principles in their service culture. Individuals who are not supported by their organisation or service can also benefit from trauma-informed practice by creating groups of likeminded peers for support.

Recognising my experiences as vicarious trauma has been useful. I now know the early warning signs of overwhelm and I know what to do about it. I am better at looking after myself, which then enables me to keep doing the important work I do. These insights have also helped to make me a leader who places more importance on looking after the people I work with.

Older people have the right to be treated with dignity and respect in their families, communities and services, but Australia has a long way to go before those rights are a reality. Until then, those of us who are passionate about the rights of older people need to be aware of the effects of vicarious trauma on our wellbeing.

We must do this – not only so we can continue doing the important work we do, but also because care service workers are valuable, too.

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.