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June 24, 2024

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Understanding PTSD in the Elderly: A Review of Trauma-Informed Care


As we continue our focus on Posttraumatic Stress Disorder (PTSD) Awareness Month, members of the Post-Acute Care Behavioral Health team discuss how the disorder affects older adults. Jessica Stone, MSN, PMHNP- BC, Supervisory Clinical Lead and Sheleigh Highsmith, PMHNP-BC, Supervisory Clinical Lead explain how to recognize symptoms in the elderly and address them.

What is PTSD?

Post-Traumatic Stress Disorder (PTSD) is a mental health condition triggered by experiencing or witnessing a traumatic event. Although it is often associated with combat veterans, PTSD can affect anyone who has endured severe stress, including the elderly. According to the American Veterans Association, approximately 70% to 90% of adults aged 65 and up have been exposed to at least one potentially traumatic event during their lifetime. PTSD symptoms may increase with age due to multiple factors including role changes, functional losses and maladaptive behaviors to cope with loss.

Challenges of assessment and treatment

Older adults are less likely to report symptoms associated with trauma such as depression or anxiety, due to an inability to connect emotional syndromes manifesting as somatic complaints. There is also a perceived stigma among this population of “seeming crazy” making it particularly difficult for primary care providers to detect trauma symptoms of the elderly compared to younger counterparts. Consequently, this may result in inadequate treatment plans, provision of poorly focused or inappropriate treatment and poor patient outcomes.

Trauma Informed Care

Patients in the long-term care setting face an elevated risk of trauma-related challenges, which are often significantly under recognized in this population. Implementing trauma-informed care is crucial. This framework acknowledges trauma’s impact on patients and guides healthcare providers in their interactions. It involves identifying trauma symptoms, implementing informed policies, practices, and procedures, and actively working to reduce the risk of re-traumatizing patients.

Effective November 28, 2019, trauma-informed care became a focal point in the survey process for nursing and skilled nursing facilities as CMS completed the final stage of revised participation requirements for Medicaid and Medicare. New trauma-informed care regulations include:

  • F699: Trauma-informed care (quality of care)
  • F659: Comprehensive care plans/qualified persons
  • F741: Sufficient/competent staff for behavioral health needs
  • F949: Behavioral health training

Application of Trauma Informed Care

Implementing trauma-informed care in long-term care settings involves several key strategies. These strategies include staff training to recognize and respond to signs of trauma, creating a safe and supportive environment and the development of personalized care plans.

The Trauma-Informed Care assessment should be conducted on all residents by a facility staff member. If any positive responses are identified during the assessment, a referral to a Behavioral Health provider for further evaluation and treatment is required. This evaluation may reveal the need for a specialized treatment plan. Additionally, regular interdisciplinary team meetings can continue to help in identifying and mitigating potential triggers, and improve communication among the treatment team, residents, and families.

By incorporating these practices, facilities can ensure that they meet the CMS trauma-informed care regulations and improve quality care to their residents while also fostering a supportive and understanding environment.

Our behavioral health program includes psychiatrists, psychiatric nurse practitioners and psychologists who work closely with facility staff to understand and assess each treatment plan for conditions like PTSD and others that affect the elderly population. Please get in touch with our team to learn more about partnering with us.