Abstract
Objective
Major life changes can trigger a traumatic stress response in older adults causing
trauma symptoms to resurface. In 2019, the Centers for Medicare and Medicaid Services
released the requirement, without specific guidance, for trauma-informed care (TIC)
as part of person-centered care in long-term care.
Design
Observational, cross-sectional.
Setting and Participants
A total of 722 new admissions at one nursing home in metro Atlanta between November
2019 and July 2021.
Methods
We developed a “TRAUMA” framework for TIC screening based on Substance Abuse and Mental
Health Services Administration resources. The admissions nurse conducted TIC screening
within 48 hours of new admissions, including reported trauma and necessary modifications
to care plans. Demographic information was derived from electronic records. Analysis
included independent sample t-tests, binary logistic regression, and χ2 tests. All data were analyzed using SPSS v. 28.
Results
Of 722 new admissions, 45 (6.2%) indicated experiencing trauma. There was no significant
association with being Black or non-White and experiencing trauma, but there was a
significant association with being female and experiencing trauma (χ2 (1) = 5.206, P = .022). Only men reported child physical abuse and war trauma and only women reported
adult sexual assault, child sexual assault, adult domestic violence, school or community
violence, adult nonintimate partner violence, and other trauma. There was a small,
significant negative association of age and trauma (β = −0.037; SE = 0.11; P < .001). The most-reported trauma category was medical trauma, including COVID-related
trauma. More than half (51%) requested spiritual intervention and only 2 requested
medical intervention with medication as initial interventions.
Conclusions and Implications
Our experience suggests that knowing the patient and their trauma history allowed
the admissions nurse and interdisciplinary care team to modify the person-centered
care plan to best meet the patient's needs. Our results also emphasize the need for
using universal trauma precautions in all interactions.
Keywords
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Article info
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
ScienceDirect
Access this article on ScienceDirectRelated Podcast
September 28, 2022
September 2022: Person-Centered Care, Trauma Informed Care, New Onset Seizures, and Transitions to Home Care
Host: Karl Steinberg MD, HMDC, CMD; Guests: Philip Sloane MD, MPH; Mallory Brown, MD
Topics: Person-Centered Care, Trauma Informed Care, New Onset Seizures, and Transitions to Home Care
https://mcdn.podbean.com/mf/download/4mjx78/JOTG-2022-09-28_mixdown.mp3
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