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



      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.


      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.


      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.


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Harris M.E.
        • Fallot R.D.
        Using Trauma Theory to Design Service Systems.
        Jossey-Bass/Wiley, 2001
        • Substance Abuse and Mental Health Services Administration
        SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884.
        Substance Abuse and Mental Health Services Administration, 2014
        • Gilbert L.K.
        • Breiding M.J.
        • Merrick M.T.
        • et al.
        Childhood adversity and adult chronic disease: an update from ten states and the District of Columbia, 2010.
        Am J Prev Med. 2015; 48: 345-349
        • Merrick M.T.
        • Ford D.C.
        • Ports K.A.
        • et al.
        Vital signs: estimated proportion of adult health problems attributable to adverse childhood experiences and implications for prevention—25 states, 2015–2017.
        MMWR Morbid Mortal Wkly Rep. 2019; 68: 999
        • Felitti V.J.M.D.
        • Anda R.F.M.D.
        • Nordenberg D.M.D.
        • et al.
        Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study.
        Am J Prev Med. 1998; 14: 245-258
        • Bearer E.L.
        • Mulligan B.S.
        Epigenetic changes associated with early life experiences: saliva, a biospecimen for DNA methylation signatures.
        Curr Genomics. 2018; 19: 676-698
        • Krause N.
        • Shaw B.A.
        • Cairney J.
        A descriptive epidemiology of lifetime trauma and the physical health status of older adults.
        Psychol Aging. 2004; 19: 637-648
        • Prohaska T.R.
        • Peters K.E.
        Impact of natural disasters on health outcomes and cancer among older adults.
        Gerontologist. 2019; 59: S50-S56
        • Stewart I.J.
        • Poltavskiy E.
        • Howard J.T.
        • et al.
        The enduring health consequences of combat trauma: a legacy of chronic disease.
        J Gen Intern Med. 2021; 36: 713-721
        • Knight L.
        • Hester M.
        Domestic violence and mental health in older adults.
        Int Rev Psychiatry. 2016; 28: 464-474
        • Rutherford B.R.
        • Choi C.J.
        • Chrisanthopolous M.
        • et al.
        The Covid-19 pandemic as a traumatic stressor: mental health responses of older adults with chronic PTSD.
        Am J Geriatr Psychiatry. 2021; 29: 105-114
        • Forman-Hoffman V.L.
        • Bose J.
        • Batts K.R.
        • et al.
        Correlates of lifetime exposure to one or more potentially traumatic events and subsequent posttraumatic stress among adults in the United States: results from the Mental Health Surveillance Study, 2008–2012. CBHSQ Data Review.
        Substance Abuse and Mental Health Services Administration, 2016
        • Davison E.H.
        • Kaiser A.P.
        • Spiro III, A.
        • Moye J.
        • King L.A.
        • King D.W.
        From late-onset stress symptomatology to later-adulthood trauma reengagement in aging combat veterans: taking a broader view.
        Gerontologist. 2016; 56: 14-21
        • Paratz E.D.
        • Katz B.
        Ageing Holocaust survivors in Australia.
        Med J Australia. 2011; 194: 194-197
        • Barman R.
        • Detweiler M.B.
        • Kim K.E.
        PTSD in combat veterans with cognitive decline.
        Federal Practitioner. 2016; 33: 17S-21S
        • Chopra M.
        PTSD in late life: special issues.
        Psychiatric Times. 2018; 35
        • Pless Kaiser A.
        • Cook J.M.
        • Glick D.M.
        • Moye J.
        Posttraumatic stress disorder in older adults: a conceptual review.
        Clin Gerontologist. 2019; 42: 359-376
        • Substance Abuse and Mental Health Services Administration
        Tip 57: Trauma-informed care in behavioral health services.
        • Hamberger L.K.
        • Barry C.
        • Franco Z.
        Implementing trauma-informed care in primary medical settings: evidence-based rationale and approaches.
        Journal of Aggression, Maltreatment & Trauma. 2019; 28: 425-444
        • Racine N.
        • Killam T.
        • Madigan S.
        Trauma-informed care as a universal precaution: beyond the adverse childhood experiences questionnaire.
        JAMA Pediatr. 2020; 174: 5-6
        • Williamson L.F.
        • Kautz D.D.
        Trauma-informed care is the best clinical practice in rehabilitation nursing.
        Rehabil Nurs. 2018; 43: 73-80
        • Hales T.W.
        • Nochajski T.H.
        • Green S.A.
        • Hitzel H.K.
        • Woike-Ganga E.
        An association between implementing trauma-informed care and staff satisfaction.
        Adv Soc Work. 2017; 18: 300-312
        • National Child Traumatic Stress Network
        Trauma types.
        Date accessed: November 10, 2021
        • Didyk N.E.
        • Jamieson L.M.
        When safety measures do harm: re-traumatization of trauma survivors living in long-term care during the Covid-19 pandemic.
        J Am Med Dir Assoc. 2021; 22: 2269-2270
        • Ditlevsen D.N.
        • Elklit A.
        The combined effect of gender and age on post traumatic stress disorder: do men and women show differences in the lifespan distribution of the disorder?.
        Ann Gen Psychiatry. 2010; 9: 1-12
        • Hiskey S.
        • McPherson S.
        That's just life: older adult constructs of trauma.
        Aging Ment Health. 2013; 17: 689-696
        • Alcendor D.J.
        Racial disparities-associated Covid-19 mortality among minority populations in the US.
        J Clin Med. 2020; 9: 2442
        • Peres J.F.
        • Moreira-Almeida A.
        • Nasello A.G.
        • Koenig H.G.
        Spirituality and resilience in trauma victims.
        J Relig Health. 2007; 46: 343-350
        • Bridgland V.M.
        • Moeck E.K.
        • Green D.M.
        • et al.
        Why the Covid-19 pandemic is a traumatic stressor.
        PLoS One. 2021; 16: e0240146

      Related 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

      Loading ...