I was recently asked to evaluate a skilled nursing resident who, in his short time at the facility, was presenting a confusing picture to staff. They perceived the resident’s presentation as indicative of a psychiatric diagnosis (perhaps bipolar disorder or personality disorder). Their impressions were reasonable, considering his labile mood, outbursts and frequently oppositional and demanding behavior. However, following an in-depth interview it became clear that a more likely diagnosis was post-traumatic stress disorder.
During the evaluation, the resident related serving in the military for 20 years and experiencing significant combat exposure. He experienced additional trauma when his wife was killed in the World Trade Center attack of 9/11. He gradually began to withdraw socially, and prior to his admission was living alone in a mobile home in a rural area.
Beyond his behavioral presentation, other symptoms included frequent nightmares, sleeping problems and panic episodes. He often overreacted, and was unreasonably controlling around his care routine. Based on this additional information, his diagnosis and care planning began to move in a completely different direction.
While any individual can experience trauma, not just veterans, this case serves as a perfect example of why we treat the individual and not the symptoms.
To effectively manage these residents, is critical that skilled nursing staff understand trauma reactions, why they persist, and how to differentiate them from other mental health issues. Post-trauma reactions have multiple contributing factors, and helpful clinical responses must take them all into account and integrate not only medical management, but also psychological, interpersonal, and environmental efforts into the daily care routine.
For the full text of this article by Robert W. Figlerski, Ph.D., click here to visit McKnight’s Long-Term Care News.