Care Partner Training: Trauma-Informed Care and Dementia

Trauma-informed care involves acknowledging that past and recent events may have been traumatic for older adults, and assessing and planning care to reduce or prevent re-traumatization.

During a recent presentation hosted by Insight Memory Care center, in collaboration with AARP Virginia, Chrissy Cunningham, prevention coordination specialist for the Fairfax County Department of Community and Neighborhood Services, provided advice for care partners of dementia patients who have experienced trauma.

Individual trauma results from an event, series of events, or set of circumstances that is physically or emotionally harmful or life-threatening and has lasting adverse effects on the individual’s well-being.

When it comes to older adults who have experienced trauma, Cunningham said professionals employ a “four Rs” approach, including realization, recognition, responding, and resisting re-traumatization.

Realization that many older adults with dementia may have experienced trauma is the first step, said Cunningham. “Universal precaution, presuming everyone may have been affected,” is important, she said.

Recognition by a care partner is key. Individuals could have intrusive recollections or thoughts, recurring dreams, and irritability. They often respond to triggers that remind them of the event where they experienced trauma.

Triggers may include dates, such as the date of a bereavement; a rigid regime within a care setting, which may remind them of a prison camp; or a noise or place, reminding them of past abuse.

“You may not always know the story,” said Cunningham, but it’s important to “acknowledge that events may be traumatic and try to prevent re-traumatization.”

Creating a safe environment, both physically and emotionally, and establishing trust are keys to responding to older adults who have experienced trauma. “The more we can offer choices, the more people feel they have control,” said Cunningham. This could be as simple as having them choose mealtimes or meal selections.

Using an empowerment-focused perspective helps promote resilience and healing and reduce re-traumatization.

“All human brains adapt to experience,” said Cunningham. The brain is never fixed but continues to change with new experiences. Helping patients find healthy coping skills exposes their brains to new experiences that can diminish the stress from trauma.

Examples of healthy coping skills include listening to music, deep breathing, spending time with others or with nature, keeping a journal, meditation, and talking to others.

How you approach an individual about past trauma is important. “Don’t probe for details,” said Cunningham.

A soft approach would be to say, “Some people have told me about difficult experiences they had during their lifetimes, such as being threatened or abused. Has anything like that ever happened to you?”

Once the person has acknowledged the experience, it’s appropriate to validate the response, such as by saying, “That must have been very frightening.”

The care partner can also normalize the response by saying “You are not alone” or “I know this has happened to others.” Be sympathetic, but don’t minimize the trauma.

Cunningham shared several techniques to help intervene and address trauma in older adults. One such technique is psychological first aid. Similar to medical first aid, this is an evidence-based approach to help reduce stress caused by traumatic events and foster both short- and long-term adaptive functioning.

Psychological first aid, which can be practiced by any care partner, includes five key principles. The first is providing a sense of safety, both physical and psychological. Psychological safety means protecting a person from situations that cause further stress, such as negative news reports.

The second principle, calming, helps people cope with strong emotions, such as helping them use some of the coping skills mentioned above.

Promoting a sense of self and community efficacy helps people have control by encouraging them to see a link between the actions they take and positive outcomes. It could be as simple as reminding people of their own abilities and strengths.

Connectedness is also crucial to trauma recovery. Social connections help people solve problems through information sharing and helping with daily tasks. They also help people gain emotional understanding and acceptance of what happened.

Finally, instilling hope is important because many who experience trauma have a sense of hopelessness. Hope helps teach them to take one step at a time so they can begin to look forward.

Psychological recovery is another technique that recognizes reactions to triggers and helps the person cope. For example, the person may experience high blood pressure, clammy hands, or sweating. Recognizing these symptoms and helping with coping strategies helps restore the person’s sense of control.

Focused cognitive behavioral therapy involves identifying unhelpful thoughts as a result of the trauma, evaluating the validity of these thoughts and challenging the thoughts that are incorrect, and replacing the dysfunctional thoughts with more helpful ones.

Eye movement desensitization and reprocessing (EMDR) therapy activates the memory processing function in the brain. During EMDR, the person makes side-to-side eye movements, following a therapist’s moving finger, while recalling the traumatic incident. Studies show EMDR can help change the negative way a person thinks about an incident.

Cunningham shared information from MindEd for Families, an easy-to-follow resource for older adults and their families that offers advice about trauma and its effects, including practical suggestions for family and friends.