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Concern About Past Trauma Among Nursing Home Admissions: Report From Screening 722 Admissions

      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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      Related Podcast

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      Host:  Karl Steinberg MD, HMDC, CMD; Guests: Philip Sloane MD, MPH; Mallory Brown, MD 

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