The Elder Justice Resource Guide includes information about elder abuse, accessible courtrooms for older adults, capacity and confusion, effective communication, and available resources for older adults experiencing abuse. The Guide also includes a comprehensive directory of national, state, and local services available to older adults.
What is Trauma?
According to the United States Substance Abuse and Mental Health Administration (SAMHSA), trauma is the result of an event, series of events, or set of circumstances experienced as physically or emotionally harmful—and at the extreme, life threatening—with lasting adverse effects on a person’s physical, social, emotional, or spiritual functioning and well-being. Trauma can stem from interpersonal events such as childhood abuse or neglect or physical, emotional, or sexual abuse, as well as singular occurrences such as accidents or more sweeping cultural or historical experiences like war, natural disasters, or racial injustice. Seventy percent (70%) of adults in the United States have experienced some type of traumatic event at least once in their lives. Because of the pervasive nature of trauma and its wide ranging and long-lasting impact, it is important for professionals working with older adults in any capacity to have a general understanding of trauma.
What are the effects of trauma?
Trauma can have a variety of physical, cognitive and psychological effects, which may continue to manifest throughout an individual’s life, even decades after a trauma has been experienced. According to SAMHSA, common effects of trauma include:
- Headaches, backaches, stomachaches, etc.
- Changes in sleep patterns, appetite, interest in sex
- Easily startled by noises or unexpected touch
- More susceptible to colds and illnesses
- Increased use of alcohol or drugs
- Fear, depression, anxiety
- Outbursts of anger or rage
- Emotional swings
- Nightmares and flashbacks – reexperiencing the trauma
- Tendency to isolate oneself or feelings of detachment
- Self-blame, survivor guilt or shame
- Diminished interest in everyday activities
- Disorganized thinking, difficulties with attention and memory
How does aging interact with an individual’s trauma history?
As people get older, they continue to experience the same wide-ranging effects of trauma, which can be present throughout the lifespan. Moreover, older adults are more likely to have experienced multiple traumas, whose effects may influence or compound each other. Older adults today are likely to have lived through historical traumas such as war, economic depression, and racial injustice, coupled with their own personal histories.
Some cultural traumas, such as the Covid-19 pandemic, may have particularly pronounced effects on older adults. Additionally, complex brain changes as people age impact memory, as well as cognitive and emotional processing. Common effects of trauma, such as disorganized or agitated behavior, faulty memory and even self-neglect, are similar to some common effects of aging, making trauma particularly difficult to identify in this population. Neuroscientists are just beginning to explore the ways in which aging may impact how both longstanding and new traumas impact the brain. The Centers for Medicare and Medicaid Services recently promulgated new federal regulations requiring all long-term care communities to be fully trained in trauma-informed care, an indicator of a growing understanding of the critical relationship between the two fields.
What do professionals working with older adults with dementia need to know about trauma?
Research suggests that a trauma history can profoundly impact the way individuals age. Trauma has been described as a form of “accelerated aging,” and some scientists believe individuals with a trauma history may be at increased risk for developing dementia as they age. Symptoms of trauma can also be confused with cognitive decline. Trauma symptoms become more severe, or even surface for the first time among older adults with dementia. This symptomatology can be expressed regardless of whether the traumatic event occured recently or in the past. It is also possible traumatic memories are more resistant to the effects of dementia, and become more prevalent as other memories fade. A thorough scientific understanding of the relationship between trauma and dementia is still in its infancy, making practical, problem-solving techniques particularly critical.
How are elder abuse and trauma connected?
According to the Centers for Disease Control (CDC), elder abuse is an intentional act, or failure to act, by a caregiver or another person in a relationship involving an expectation of trust that causes or creates a risk of harm to an older adult. In the United States, one in ten people age 60 and older experience elder abuse each year. Elder abuse may cause trauma, particularly given the intimate nature of the relationship between the older adult and the individual causing harm, and because elder abuse is generally not a one-time occurrence, but a pattern perpetuated over months or even years. Research suggests earlier life traumas make a person more vulnerable to experiencing further trauma, and for many older adults, elder abuse may be the most recent in a series of traumas accumulated through a lifetime. Coupled with the significant physical and socio-emotional changes many people experience as they age, elder abuse may be a source as well as a trigger of trauma with wide ranging impact.
How can elder justice professionals respond to traumatic triggers and minimize re-traumatization when working with older adult clients?
Trauma informed practices are critical to effectively addressing elder abuse. The Weinberg Center for Elder Justice, the first comprehensive elder abuse shelter in the nation, was launched at the Hebrew Home at Riverdale in 2005 to provide emergency shelter and wrap around support to older adults experiencing abuse. Through our provision of intensive, holistic services to hundreds of trauma survivors, the Weinberg Center professional team has learned several key lessons. As a matter of best practices, elder justice professionals across disciplines must:
- Educate themselves about trauma and train themselves to identify common effects of trauma.
- Prioritize understanding clients’ trauma histories and triggers.
- Consider the process and not just the goal when working with clients who have experienced trauma.
- Provide effective advocacy for clients by helping other professionals to understand particular client behaviors as reactions to traumatic triggers and respond accordingly
What is re-traumatization and how can it manifest among older adults?
For trauma survivors, traumatic memories are typically associated with sensory experiences. Smells, sights, settings, noises, gestures or other stimuli that cause a trauma survivor to not only remember but relive a traumatic experience are called “trauma triggers.”
Trauma triggers are highly specific to individual survivors and can cause a variety of physical and behavioral responses, which may seem out of context or even alarming to an observer. Sadly, many systems commonly accessed by trauma survivors are designed in a way that makes trauma triggers more common, by institutionalizing practices evoking feelings of powerlessness, lack of control and physical or emotional danger. These experiences can lead to re-traumatization, ironically perpetrated by the very entities trauma survivors turn to for assistance. Ageism within medical, legal or other systems commonly accessed by trauma survivors may make these experiences even more pervasive for older adults. Furthermore, ageism may result in negative reactions to retraumatizing experiences being interpreted as typical aging, making them less likely to be effectively addressed and more likely to reoccur.
Are additional resources on trauma, aging and elder abuse available?
In 2018, the Weinberg Center and the New York City Elder Abuse Center at Weill Cornell Medicine co-convened a national symposium on advancing trauma-informed responses to elder abuse. To read the resulting publication, learn more about the state of the field of elder justice and trauma, or to learn more about the Weinberg Center, visit theweinbergcenter.org/trauma or contact Joy Solomon at Hebrew Home firstname.lastname@example.org