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All Alone: How trauma-informed practice is addressing our next public health crisiKera Magarill, MA
Oregon Older Adult Behavioral Health Specialist
Washington County Disability, Aging and Veteran Services
10/17/2019
What is our next public health crisis?
“Loneliness is a growing health epidemic….over time our personal connections have deteriorated.”
- Dr. Vivek Murthy, Former US Surgeon General
This Photo by Unknown Author is licensed under CC BY-SA-NC
Loneliness is more dangerous to your health than smoking 15 cigarettes a day
(Holt-Lundstad, PLoS 2010)
Definitions
o Loneliness –o Subjective feeling of being alone.
o It is “the distress that results from discrepancies between ideal and perceived social relationships.”o Cacioppo. U. Chicago, 2009
o Social isolation –o Few, infrequent, or total lack of social contact
o Objectively measured by the number of personal contacts that people have.
Social Isolation and loneliness are both associated with negative physical and mental health consequences.
Feeling lonely? Join the club.
1 out of 4 older adults say they feel isolated from other people
1 in 3 older adults say they lack companionship (National Poll on Healthy Aging, 2019)
13.4 % Washington County residents over the age of 65 Equates to 26,697 older adults who “lack companionship” and
20,023 feel isolated (based on 2018 US census data)
Approximately 28% people 65 and older live alone (Source 2017 Profile of Older Americans, ACL).
What’s the connection?
Older adult loneliness and trauma
A (brief) Timeline of Stress & Trauma
1920 – Domestic abuse (“wife beating”) made illegal (and women earned right to vote nationally)
1929 – Great Depression begins
1939-1945 – WWII is the largest and deadliest war of all time, 3% of the world’s population at the time
1942 – Executive order 9066 is signed, creating the first US internment camps forcing relocation and imprisonment of 120,000 Americans of Japanese descent
1955 – Rosa Parks is arrested for refusing to give up her seat on a public bus. (1956 – Supreme court rules segregation on city bus system illegal after the Montgomery bus boycott)
1961 - Illinois becomes the first U.S. state to remove sodomy law
1974 – Child Abuse Prevention and Treatment Act established
Late-life stress and trauma
Loss of a spouse or partner
Chronic or limiting medical condition
Loss of employment/retirement
Loss of mobility Sensory impairment Changing roles, caregiving
Limited resources/fixed income
Family/children move away
Increasing frailty Ageism LGBTQ older adults w/o
partner/children Elder abuse
Links between early and late life trauma
• Childhood abuse is a risk factor for elder abuse. (Allers et al., 1992; Fulmer et al.,2005; Hines & Malley-Morrison, 2005).
• Older adults who experienced early abuse are more likely to tolerate poorer care. (Fulmer, et al, 2005)
Community Health Improvement Plan
Reduce health disparities, improve health equityand apply a trauma-informed lens to all CHIP work. Trauma-informed toolkit
The Older Adult Behavioral Health Committee is focused on improving community health outcomes by implementing strategies to address anxiety and depression in older adults in our community.
Creating connection to community
Death Cafe Memory Cafe
Preparing for the cafe
Partners: City of Beaverton Council on Aging, Center for Mediation and Dialogue, Library
Peer facilitators, multi-language
Trained in: Trauma informed facilitation
Gatekeeper training w/ ADRC
Suicide prevention (OA QPR)
Partners: Pacific University Social Work, Diversity Café
Intergenerational conversation leaders
Trained in: Disease specific education
Trauma-informed approach communication using Long TermCare Culture Change best practices
Death Cafe Memory Cafe
Modifying the environment
Libraries Multiple tables
Older Adult fidget baskets
Restaurant/bar Extra signage
Greeters/extra support people
Dementia fidget basket
Death Cafe Memory Cafe
Program
TIC Meeting guidelines Cake and a variety of
options
TIC “Starting the meeting guidelines”
Question promptsrelated to topic
TIC Meeting Guidelines Cinnamon Rolls
TIC “Starting the meeting guidelines”
Intergenerational question prompts
Death Cafe Memory Cafe
Speaking the language of aging care systems
Bridging the Gap
Aging & long term care culture change
• Safety: Increasing clients’ physical and emotional safety
• Trustworthiness: Maximizing trustworthiness, making
tasks clear, and maintaining appropriate boundaries
• Choice: Prioritizing client choice and control
• Collaboration: Maximizing collaboration and sharing of
power with clients
• Empowerment: Prioritizing client empowerment and skill
buildingFallot, 2011
Validation Method
Validation Method - Validation is a method of communicating with disoriented very old people that helps reduce stress, enhance dignity and increase happiness. Validation is built on an empathetic attitude and a holistic view of individuals. Validation practitioners are “caring, non-judgmental and
open to feelings that are expressed”. Practitioners are trained to “step into their shoes” and “see
through their eyes”
Person-centered care
Philosophy of care in which a person’s values, wishers, and preferences guide all aspects of care, services, and support to achieve realistic health and life goals.
Culture change models and tools
Positive physical approach – honors physical boundaries when providing care
Bathing without a battle – creates more opportunities for privacy and dignity during invasive care
Best Friends Approach – Residents have the right to be treated like adults
Principles of a dignified diagnosis – Persons with dementia have the right to be informed
Eden Alternative – Environmental changes
The Pioneer Network
All elders are entitled to self-determination wherever they live.
Community is the antidote to institutionalization. Shape and use the potential of the environment in all
its aspects: physical, organizational, psycho/social/spiritual.
Recognize that culture change and transformation are not destinations but a journey, always a work in progress.
Eden Alternative
Activity Therapy
Plan for a varying skills and abilities
Be aware of physical or sensory problems
Process, not product – Art vs. “craft”
Sensory stimulation
Adult in nature – activities and materials
Relate activity to life story
Be flexible
Break activities into simple, easy-to-
follow steps
Make a connection – avoid meaningless
activity
Encourage self expression
Involve the person through conversation
– ice breakers, get to know you and
discussion starters
Stimulate the five senses
Doing nothing is actually doing
something
Activities should be voluntary
Activities can be short
Activities we think “won’t work”
sometimes will
Adapted from “Best Friends Activities” and Alzheimer’s Association Activities
Common themes with TIC
Autonomy
Individuality
Choice
Dignity
Comfort
Security
Control
Trauma-informed fidget baskets
AKA “Rummage boxes”, “Life skill stations”, “Fiddle quilt/apron/cat”, “Sensory Stimulation”, “Montessori Method”, and others
• Knitting needles and yarn
• Croquet hooks and yarn
• Shells
• Seek and finds – rice, beans, sand
• Cinnamon and cloves
• Origami paper
• Watercolor pencils, markers, paintbrushes
• Adult coloring sheets
• Cough drops
• Ribbon/lace/fabric
• Antlers
• Wooden eggs
• River stones
• Live plants
• Feathers
• Wooden beads, leather lace
• Large print dot-to-dot, sudoku
• Pictures, postcards
• Springs
• Guitar picks
• Paperclips
• Clothespins
• Buttons
• Large piece puzzle (<25 pcs)
• Sand paper & wood block
Oregon’sOlder Adult Behavioral Health Initiative
(OABHI)
More trainings:
Hoarding Disorder
Anxiety and Depression in Older Adults
Suicide Prevention
Older Adult Mental Health First Aid
Dementia, Delirium and Depression:
Oregon’sOlder Adult Behavioral Health Initiative
(OABHI)Phone:
Clackamas County
Kim Whitely 971-413-3454
Multnomah County
Jill Williams 503-367-3803
Laurel Wonder 503-988-2868;
Max Harvey 503-988-2845
Washington County
Kera Magarill 720-210-8481
Email:
Clackamas – [email protected]
Multnomah – [email protected]
Washington – [email protected]