To the Editor:
There is a pressing need to uncover the untold stories of retraumatization experienced by trauma survivors residing in congregate living settings in Canada during the COVID-19 pandemic. Beyond disproportionate death tolls, we know that safety measures imposed in long-term care (LTC) homes, such as visitor restrictions and group activity cancellations, had many negative effects on residents’ health and well-being. “Confinement syndrome” has been used to describe the significant and likely irreversible physical, cognitive, psychological, and functional declines associated with sensory deprivation and a lack of social engagement.
1
, North Simcoe Muskoka Specialized Geriatric Services
Confinement syndrome.
Confinement syndrome.
https://www.nsmsgs.ca/Uploads/ContentDocuments/Confinement%20Syndrome%20Aug17-20.pdf
Date accessed: July 30, 2021
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One subgroup of older adults especially vulnerable to these effects—and about whom more research is needed—are trauma survivors.Research outside of Canada has given some attention to understanding how COVID-19 measures may have retraumatized trauma survivors and underscores the need for similar research in Canada.
For instance, in Europe, a team of psychoanalysts call the enforcement of COVID-19 quarantine measures a “warlike situation” and describe high levels of panic, anxiety, and fatigue among patients from the former Yugoslavia.
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Likewise, older Spaniards who lived through the Spanish Civil War and postwar dictatorship have been overwhelmed by government officials’ use of words like “fighting” and “surviving'' when referring to the COVID-19 pandemic because this language brings back traumatic memories of war and postwar hardships, which many are having to cope with in isolation.5
Similarly, Israeli researchers have identified that restrictions placed on social interactions at the start of the pandemic were triggering early life losses for care home residents, many of whom are Holocaust survivors.
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In response to concerns about retraumatization, visiting resumed inside Israeli care homes after 4 weeks, though at reduced capacity.7
This reversal contrasts sharply with the 6-month-long visitor restriction policies enforced in many LTC homes in Ontario, Canada.Ministry of Health
Visitation protocol in residential settings for older adults and people with disabilities.
Visitation protocol in residential settings for older adults and people with disabilities.
https://www.gov.il/en/departments/news/21042020_01
Date accessed: August 6, 2021
2
At the same time, comparable research in Canada cannot ignore our colonial context and the resulting intersections between trauma, race, and ethnicity. For example, Indigenous populations in Australia (particularly those with lived experience of being confined to missions and reserves under colonial policies) experienced declines in well-being during stay-at-home and lockdown orders led to declines in well-being due to disconnection from family, community, culture, and country—core tenets of Indigenous culture and identity.
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In Canada, one study found that immigrants living in LTC whose primary language was non-English were at higher risk of hospitalization.The Healing Foundation
Stolen generations.
Stolen generations.
https://healingfoundation.org.au/stolen-generations/
Date accessed: August 7, 2021
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Research conducted before the pandemic in the United States found that black and Hispanic LTC home residents had diminished social engagement compared to their White counterparts.10
The same is likely true in Canada.In short, this brief survey of the existing research highlights the urgent need for similar studies in Canada. Above all, we must uncover resident, particularly BIPOC, stories to understand how their past and present lived experiences shaped health outcomes during the pandemic—and how they may do so in future pandemics. Such research should ensure consistent collection and analysis of race-based data, and data from those residents whose traumas stem from lived experiences with racism and cultural isolation. These residents likely bore the greater burden of the pandemic and more profound effects of “confinement syndrome.” Understanding their experiences is necessary to ensure that all Canadians have equal access to high-quality health care.
In the end, given Canada’s disastrous outcomes during the COVID-19 pandemic, all LTC and retirement homes should be working to adopt trauma-informed practices to minimize the retraumatization of residents in future pandemics. It is hoped that the research recommended above will further this goal by providing insights into the effects of isolation on trauma survivors as well as marginalized communities. Proper resident care in Canada’s LTC sector cannot afford otherwise.
References
- Confinement syndrome.(Available at:)https://www.nsmsgs.ca/Uploads/ContentDocuments/Confinement%20Syndrome%20Aug17-20.pdfDate accessed: July 30, 2021
- COVID-19 and Ontario’s long-term care homes.Science Briefs of the Ontario COVID-19 Science Advisory Table. 2021; 1
- Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)-related deaths in French long-term care facilities: The “Confinement Disease” is probably more deleterious than the coronavirus disease-2019 (COVID-19) itself.J Am Med Dir Assoc. 2020; 21: 989-990
- Isolation in COVID-19 pandemic as re-traumatization of war experiences.Croat Med J. 2020; 61: 371-376
- Memories of war and the COVID-19 crisis in Spain.Hum Arenas. 2021; 4: 366-378
- The coronavirus pandemic and Holocaust survivors in Israel.Psychol Trauma. 2020; 12: 502-504
- Visitation protocol in residential settings for older adults and people with disabilities.(Available at:)https://www.gov.il/en/departments/news/21042020_01Date accessed: August 6, 2021
- Stolen generations.(Available at:)https://healingfoundation.org.au/stolen-generations/Date accessed: August 7, 2021
- Health outcomes of immigrants in nursing homes: A population-based retrospective cohort study in Ontario, Canada.J Am Med Dir Assoc. 2020; 21: 740-746
- Racial and ethnic disparities in social engagement among US nursing home residents.Med Care. 2014; 52: 314-321
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Published online: September 03, 2021
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© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
