Recent research is identifying relationships between post-traumatic stress and dementia. The social and emotional wellbeing framework referred to in my earlier post acknowledges the significance of trauma in Indigenous people’s lives. In The Conversation, Vasiliki Orgeta found that:
post-traumatic stress disorder (PTSD) [is] a potential risk factor for developing dementia. PTSD is caused by traumatic experiences such as childhood trauma, war or being the victim of violence or abuse. People with PTSD experience distressing symptoms, often for many years. These symptoms can include flashbacks of the traumatic event, avoiding reminders of the event, hyper-arousal, and memory deficits related to traumatic experiences.
The possible (or likely) impacts of trauma became evident as my mother’s dementia progressed. She referred to and reacted to situations from her earlier life that were truly traumatising. The medical response to this was to medicate with anti-psychotics – using that disempowering phrase “taking the edge off” – rather than understanding the trauma.
Orgeta’s research found 13 studies linking post-traumatic stress disorder (PTSD) and dementia. All but one of the studies found an increased risk of developing dementia for those experiencing PTSD. The researchers investigate the likely causes of this including the impact of PTSD on the brain and the impact of PTSD to other risk factors. The authors propose that, as a risk factor, PTSD can be modified through access to appropriate mental health and counselling services. However, they are also unsure about whether addressing PTSD reduces dementia risk.
Other studies have found that dementia can be a risk factor in developing “delayed-onset PTSD”, which “refers to the emergence of PTSD in an individual, sometimes years after a traumatic event or events have occurred”. In proposing trauma-informed dementia care, J. Scott Janssen refers to the experience of a man living with dementia who had traumatic experiences of cold with the response to keep environments warm and minimising the use of water due to a near drowning experience. A trauma-informed approach can be used even when trauma has not been identified. Although aged care facilities don’t account for how they traumatise people living in them. Dementia Training Australia also has resources addressing trauma-informed care and the Phoenix Australia has produced a fact sheet.
Trauma experienced by Aboriginal and Torres Strait Islander people is poorly understood by the care system. Dr Carmen Cubillo has found “Trauma-informed care is often poorly defined in Australia’s healthcare field and is even less defined when working with Aboriginal and Torres Strait Islander people.” Together with her team, Dr Cubillo has developed an evidence-based program that “seeks to address some missing elements of trauma-informed care in Australia through a process for knowing, being and doing with Aboriginal and Torres Strait Islander people”. It is underpinned by the knowing of the real history of this country and the impacts of that history on Indigenous people and draws on the social and emotional wellbeing framework developed by Gee et al.
For Dr Cubillo, “Trauma happens in relationship and trauma is healed within relationship”. She stresses the need for working in ways that are both trauma informed and culturally responsive which “honour an Aboriginal worldview of holistic identity, connection and wellbeing”. Given that 11% of Aboriginal and Torres Strait Islander people born before 1972 were removed from their families, Elders now living with dementia could have endured stolen generation trauma. According to the Healing Foundation:
Survivors who develop dementia may experience terrifying flashbacks to their childhood, which they are unable to distinguish from reality. Aboriginal and Torres Strait Islander people are three to five times more likely to develop dementia than non-Indigenous Australians, and Stolen Generations survivors are even more likely to develop dementia as a result of the trauma they experienced.
This video provides some insight and offers reassuring trauma-informed strategies that support the agency and personhood of the person living with dementia. A dementia friendly approach must also be trauma informed.
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Posted on 08/05/2023
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