The case for trauma‐informed aged care

Cations, Monica; Laver, Kate; Walker, Ruth; Smyth, Alison; Fernández, Elízabeth; Corlis, Megan

doi:10.1002/gps.5247

Cited by 19 publications

(30 citation statements)

References 34 publications

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“…Receiving aged care services introduces a power imbalance requiring high levels of trust. 13 Participants provided insights into building trust through communicating intent and being sensitive to perceptions of control loss which might manifest in questioning behaviour. Forewarning of intentions before undertaking any activity and including participants in decisions (however trivial) were measures suggested to avoid anxiety escalation.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, clear communication is recommended in all aged care practice 24 but is particularly important for survivors of psychological trauma where staff may not have a comprehensive understanding of triggers. 13 Together with mistrust and control concerns, Forgotten Australians highlighted the potential for re-triggering of trauma, together with concerns about disclosure, service provider competence and financial barriers to accessing care all linked to the enduring effects of childhood institutionalism. Some participants were frustrated with the complexity of accessing aged care services online and the burden of administration which has been acknowledged elsewhere.…”

Section: Discussionmentioning

confidence: 99%

“…28 Staff delivering aged care to this population will require appropriate training in trauma-informed care that would incorporate knowledge of coping strategies. 13 The availability of ongoing psychological counselling was regarded as necessary for survival and ageing well by all participants. Several studies have demonstrated the importance of these services for older people with post-traumatic stress disorder, 29 and these supports may help to buffer the toll that experiences of childhood institutionalisation had on life opportunities and potential.…”

Section: Discussionmentioning

confidence: 99%

“…10 Research with other groups who have experienced traumatic events, including genocide survivors 11 and older women who have survived sexual abuse, 12 notes that aged care services inherently introduce power imbalances and loss of control that can evoke distressing memories and intensify trauma-related fear, grief and humiliation. 13 Aged care practices (eg personal care) and environments (eg locked wards) can retrigger trauma reactions in ways that may be difficult for staff to understand. 11 The Forgotten Australians may have unique perspectives on aged care that may differ from other traumatised and marginalised groups.…”

Section: Introductionmentioning

confidence: 99%

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‘I’d rather die in the middle of a street’: Perceptions and expectations of aged care among Forgotten Australians

et al. 2020

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Objectives: To explore perceptions and expectations regarding aged care among older Forgotten Australians, informing better ways of delivering safe and inclusive care for this group. Methods: In-depth interviews were undertaken with sixteen Forgotten Australians to understand their perspectives, hopes and perceived barriers to receiving appropriate aged care. Qualitative data were analysed using Ritchie and Spencer's framework approach. Results: Participants were highly averse to receiving aged care in residential settings, particularly where delivered by religious organisations. Limited perceived opportunities to develop trust and maintain control and independence while managing re-traumatising situations shaped Forgotten Australians negative perceptions of the aged care system. Participants also spoke of how their lifelong marginalisation could limit their access to choice and quality in aged care. Conclusion:The aged care industry could provide safe and inclusive care by adopting a person-centred and trauma-informed model that recognises and addresses the specific needs and challenges of Forgotten Australians.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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‘I’d rather die in the middle of a street’: Perceptions and expectations of aged care among Forgotten Australians

et al. 2020

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“…This is particularly likely in the context of dementia given deficits in orientation to time and place, memory, cognitive inhibition, and communication. The loss of control implicit to receiving dementia care directly threatens the most important component of recovery from trauma [ 17 , 18 ]. There is increasing consensus that many responsive behaviours exhibited by people with dementia occur in response to unmet needs [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Trauma-informed care in geriatric inpatient units to improve staff skills and reduce patient distress: a co-designed study protocol

et al. 2021

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Background Geriatric hospital wards are highly medicalised environments with limited opportunities for choice and control, and can be distressing for older survivors of psychological trauma. While trauma-informed models of care (TIC) are effectively applied across mental health and other settings, the utility of these models in aged care settings has not been assessed. The objective of this study was to examine whether TIC can reduce responsive behaviour, chemical restraint, and improve staff skills and patient experiences in inpatient geriatric settings. Methods Four wards participated in this type I hybrid implementation-effectiveness study across southern Adelaide, Australia, including 79 beds. Using a co-design method, the principles of TIC were transformed into an implementation strategy including staff training, establishment of highly trained ‘champions’ on each ward, screening for trauma-related needs, and amending ward policies and procedures. Primary outcomes will be examined using an interrupted time-series design and are monthly incidence of responsive behaviour incidents and use of chemical restraint. Process evaluation will be used to examine secondary, implementation outcomes including the acceptability, feasibility, and fidelity to the implementation strategy. Discussion Trauma-informed care has potential to improve the safety and accessibility of hospital wards for older people who have survived psychologically traumatic events and has an extensive evidence base supporting its effectiveness in other settings. Identifying trauma-related needs and amending care to reduce the risk of re-traumatisation and distress may also reduce the incidence of responsive behaviour change, which has a significant impact on the quality of life of hospital patients and staff and is very costly. The inclusion of a process evaluation will allow us to identify and report changes made on each ward and make recommendations for future implementation efforts.

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Characterising trauma‐informed aged care: An appreciative inquiry approach

Cations

Perrelle²,

Klinge

et al. 2022

Int J Geriat Psychiatry

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Objective: While Trauma-informed care (TIC) has the potential to improve the quality of aged and dementia care, the challenge remains in translating the principles of TIC into practice. This study aimed to characterise what trauma-informed aged care looks like in practice, by learning from an aged care service acknowledged as delivering trauma-informed aged care effectively. Method:We conducted an appreciative inquiry study within a residential aged care service catering for veterans and others with trauma histories. Observation of care behaviours, interviews with staff and residents, and organisational policy mapping were used to identify elements that maximised care safety and accessibility for trauma survivors. Data were analysed and triangulated using a framework analysis approach. Results:The aged care provider embedded the principles of TIC into its staff training (i) to promote understanding of how trauma may affect experiences in care, and (ii) to adapt care when appropriate to promote safety. The service promoted a calm atmosphere where residents could make choices and felt safe. Uniforms and signage provided consistency, clarity, and transparency for residents. Staff behaviours demonstrated respect, fostered trust, and anticipated needs without unnecessarily imposing care. Staff consistently offered choices, used residents' names, sought permission before providing care, and offered reassurance. Staff reported high morale with a commitment to delivering high quality care, and feedback to management. Effective communication promoted information sharing and trust among staff. Conclusion:Trauma-informed practice was facilitated through organisational policy, a dignified environment, and thoughtful staff behaviour creating safety, choice, and control for residents. K E Y W O R D Saged care, mental health, organisational change, psychological trauma, trauma-informed care Key points� Trauma-informed care (TIC) is poorly characterised in aged care and staff require guidance in how to amend everyday practice to meet the needs of trauma survivors.

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The case for trauma‐informed aged care

Cited by 19 publications

References 34 publications

‘I’d rather die in the middle of a street’: Perceptions and expectations of aged care among Forgotten Australians

‘I’d rather die in the middle of a street’: Perceptions and expectations of aged care among Forgotten Australians

Trauma-informed care in geriatric inpatient units to improve staff skills and reduce patient distress: a co-designed study protocol

Characterising trauma‐informed aged care: An appreciative inquiry approach

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