Trauma-informed care for seniors: Even a little goes a long way


Joyce Wolpert, LCPC | Special to the JT

Trauma seems to be everywhere these days as people are claiming such responses to natural and human disasters, public or personal experiences.

(Comstock / Stockbyte)

At its essence, trauma is a shaking of the roots, a loss of foundation in one’s life with a plethora of physical, emotional and cognitive symptoms possible that may radically alter one’s relationship with others and oneself.

At the same time that trauma has expanded beyond wartime or severe physical accidents, an approach called “trauma-informed care” is now advocated as standard practice for medical personnel, first responders and mental-health clinicians. Rather than purported helpers intervening with their own agenda based on assumed pathology, the question needs to be asked of those suffering: What happened to you, and how can we work together to help stabilize your life? Clearly, the answer may be different for each person and situation.

Thus, the first key is to listen without imposing. This would be sage advice for those interacting with seniors in various situations. It is always tempting to lump seniors and their presumptive needs together. Yet by the time one gets to be older, most of us have had very unique experiences. We may not wear these on our faces or displayed in our social behavior, yet we ask you to allow for our self-expression and to respond in kind.

A guiding principle in relating to seniors is to be ever aware that this is our last hurrah — not that we’re going to die tomorrow! But that for most of us, our life trajectories are set. We’re not going to easily move away or change the people and groups we are involved with. Thus, the way we are treated in any given situation stays with us. It may bore into earlier trauma and solidify pain we have known too well and for too long. Or if the people we relate to now are sensitive and see us for whom we truly are, we may have the chance to heal from some of our earlier trauma and thus be able to face rest of our lives with our integrity intact.

I give three examples of places where you will find most seniors and how those who are well-meaning may proactively choose to relate to us. As we all too well know by now, senior-care residences are a mixed bag, and many of us try to avoid them if at all possible. For those who do live in assisted-living sites or nursing homes, there is usually much to be desired in terms of social-emotional care.

There is danger of under or overstimulation. I have witnessed nonverbal persons sit for hours with no one coming over to relate to them through sight, sound or touch. People may begin to feel they do not exist, and paranoia may overcome them. Conversely, I have seen overeager staff members pat, grab or shake people without their tacit permission. Before we venture any physical involvement, we need to know the person’s possible trauma history.

If they have experienced any type of abuse, for instance, then touch of any form, even by a caregiver, could trigger a host of reactions. Allowing the senior to take the lead is a safest way to relate. Sit next to them on their level, and notice and mirror their breathing patterns. Have an object between you, like a ball or a stretch band, so that you may engage without becoming overwhelming. And take it slowly from there.

Reach out to help the homebound

For seniors still living at home and “aging in place,” this takes a finessed approach.
These persons may have lived independently for years by choice or after death of a spouse. Many have developed firm boundaries and remain wary of asking for help, lest someone come into their space and witness unsafe conditions, and want to offer or (in the senior’s view) “impose” help. Thus, many seniors continue to live alone with inadequate food or emergency supplies’ storage; minimal meal preparation; and limited doctors’ visits or other outings due to transportation needs. They may seem to get by, but in essence, are prisoners in their own homes.

And so what might a caring friend, neighbor or relative do? Developing a cordial relationship takes an investment of time yet is the best way to get to know the senior on more equal terms and to allow for a natural engagement to take place. Rather than calling the senior (giving the sense that you’re checking up on them), instead suggest an activity you both might enjoy — attending a community or entertainment event together, meeting in a neighborhood place for coffee, or if the individual cannot get out on his or her own, offering to bring over a new dish you have made or reading material you might have. Even stopping by their house and putting some flowers by the front door will let them know you’re thinking of them without being invasive.

It is only when people feel cared for, safe and not judged that they can allow their real needs to be shown. Then you may offer some options, still allowing space for them to make their own choice. No question, this may be challenging because sometimes the senior’s choice may not make sense to you. In that case, the idea is to stand by — again without overwhelming them — and remain as witness while the situation unfolds. When the realities of their choices become known, they may be more open to hearing your gentle suggestions.

More mobile seniors who are out in the community trying to take care of their affairs continue to come up against age stereotyping and discrimination. Consider the person trying to get information from a sales clerk. A younger person may feel rushed and irritated, and find themselves treating seniors as if they are stupid and uncomprehending. Yet if the clerk would apply some patience, and talk slower and louder, this would be most helpful.

Unfortunately, interactions like this take place with medical personnel as well. Thus, the current introduction of trauma-informed care training.

The trials of technology

A big source of anxiety and feelings of powerlessness for seniors is their mostly limited abilities to learn and use new technology. Our intelligent brains have functioned one way for years. Now we are asked to radically switch gears and allow our “needs” to be met by a technology that may make life easier for others, but for us is tremendously challenging.

On an economic level, seniors are also ripe for scams. On a personal level, we may miss out on communications that would help us to feel less isolated. Yes, we need technical help. But while we are trying to pull ourselves up to this new standard, we also need your willingness to reach us in personal ways with direct communication through words that will allow us to feel your care and concern. To feel that getting our needs met is related to us pushing the right button is extremely unnerving.

The other unsettling issue is bullying. Sometimes, this occurs between seniors when they exclude another from joining a card game or an outing because they accuse the person “of not being able to keep up.” Other times this occurs with younger persons who may infer that in some way the senior is just not acceptable to take part in a group or other event. It is a fine line between condescending, allowing and inviting. While we seniors do have our limits, we also have our strengths. We ask you to pay attention, listen and find which traits have allowed us to live such long, active, and often, most interesting lives.

The overarching point here is that instead of assuming there is something wrong with a senior that requires a quick fix rather than taking the time to listen, truly hear and comprehend their life experience as together you engage in a relationship that may help to expand and uplift their quality of life.

Joyce Wolpert, DMT, LCPC, of Baltimore worked as an expressive therapist and advocate for seniors for years. Now a senior herself, she is even more committed to countering ageist stereotypes.

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