BACKGROUND: Past research has examined the health outcomes of early sexual trauma in reproductive age women, but little is known about potential long-term effects in older age. OBJECTIVE: To examine associations between early life sexual trauma and later life sexual/genitourinary dysfunction and general functional disability in women. DESIGN: Cross-sectional analysis of nationally representative observational data from the National Social Life, Health, and Aging Project (2010-2011) PARTICIPANTS: One thousand seven hundred forty-five US women aged ≥ 50 years MAIN MEASURES: Two forms of early life sexual trauma (childhood sexual abuse and unwanted first sexual experience), sexual/genitourinary dysfunction (pain during sex, lack of pleasure during sex, urinary incontinence, other urinary symptoms), and general functional disability (difficulty performing 7 activities of daily living (ADLs) or 8 instrumental activities of daily living (IADLs)), assessed by interview and questionnaire. KEY RESULTS: Of 1745 women, 11% reported a history of childhood sexual abuse and 39% an unwanted first sexual experience. Childhood sexual abuse was associated with later life sexual/genitourinary dysfunction (pain during sex [OR 1.9, 95% CI 1.1-3.3], other urinary problems [OR 1.9, 95% CI 1.2-3.1]), and difficulty with multiple ADLs/IADLs (walking across the room [OR 1.9, 95% CI 1.2-3.1], getting in or out of bed [OR 2.0, 95% CI 1.2-3.3], bathing [OR 2.0, 95% CI 1.2-3.5], prepping meals [OR 2.4, 95% CI 1.5-3.8], shopping for food [OR 1.6, 95% CI 1.0-2.4], and completing light work [OR 1.6, 95% CI 1.0-2.4]), after adjusting for age, race, and education. Unwanted first sexual experience was associated with later life lack of pleasure with sex (OR 1.7, 95% CI 1.1-2.5) and difficulty with ADLs/IADLs (walking one block [OR 1.5, 95% CI 1.1-2.1], completing light work [OR 1.6, 95% CI 1.1-2.1]) in adjusted analyses. CONCLUSIONS: Early sexual trauma may be an underrecognized marker of risk of aging-related functional decline in women. Findings underline the importance of providing trauma-informed care for women across the aging spectrum.

Background: Early clinical experiences expose students to patient-centered care. However, early incorporation of telehealth communication skills remains limited in health professions education. In this study, we aimed to design and evaluate a telephone-based clinical learning program for students to promote the development of patient-centered communication skills while addressing healthcare disparities experienced by older adults during the COVID-19 pandemic.Methods: We utilized workplace learning principles in designing a telephone-based clinical learning pilot program for health professions students at an academic geriatrics primary care clinic. Students conducted three types of telephone calls to patients that 1) assessed for unmet needs (e.g. food, medication, medical supplies, caregiving, social support, and/or access to medical care) (screening call), 2) addressed social isolation (social call), and 3) helped patients set up videoconferencing software to prepare for telehealth appointments (telehealth-training call). We tracked telephone call completion and outcomes via weekly student reports and the electronic health record. To evaluate program e cacy and learning outcomes, students completed an anonymous post-program survey that assessed pre-and postprogram knowledge and skills acquisition. Data was analyzed using descriptive statistics and Wilcoxon rank-sum tests. Results: Five medical student liaisons led 23 medical and nurse practitioner students in calling 335 patients over 13 weeks. Students successfully reached 247 patients (74%), assisted 25 patients in setting up videoconferencing software, and engaged 30 patients in weekly social calls. Of 21 students who completed the post-program survey, 18 (86%) believed this program provided meaningful clinical exposure. After participation, all students felt comfortable interacting with patients by telephone and 20 (95%) felt con dent in relationship-centered communication. Students reported increased knowledge about vulnerabilities in the geriatric population (p = 0.002). Conclusion: This telephone-based program allowed health professions students to support a vulnerable population and gain patient-centered communication skills. This program could be adapted for implementation in multiple contexts as an effective telehealth clinical learning experience, especially for pre-clerkship health professions students who could gain early exposure to telehealth and practice communication and health coaching skills with patients.

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