When working with older adults, it is essential that we understand the impact of trauma on their lives. An estimated 90% of Americans will experience a traumatic event in their lifetime, such as violence, war, disaster, and discrimination. This impact is often compounded for those that have experienced abuse, neglect, or exploitation later in life. Below are some key points for all professionals to consider when working with older adults.

• Trauma is an individual experience. An experience that is traumatic for one person may not be for another. Everyone has different coping mechanisms, histories, and reactions. Traumatic experiences may include death of a loved one, discrimination, bullying, a natural disaster, domestic or sexual violence, or elder abuse.

• Trauma presents itself differently across the lifespan. For example, older adults may be less likely to discuss emotional effects of their traumatic experiences and may be more likely to focus on somatic, physical experiences. Clients who have experienced trauma, especially those that have experienced complex trauma across the lifespan, may be distrustful of services, have difficulty with change, be irritable, and struggle with relationships.

• Changes associated with the aging process can be traumatic, such as loss of family and friends, changes in role, decline in health, and decreased independence. These experiences may be triggering of past traumas.

• Caregiving can be a traumatic experience. While in many ways rewarding, family caregiving can take an emotional, physical, and financial toll. Providing day to day care for someone, end of life planning, and anticipatory grief can all be incredibly challenging. Caring for an individual with a history of trauma may be even more complex, as loved ones have to manage trauma symptoms and behaviors.

• Trauma does not have to be experienced directly to have an impact on one's well-being. Individuals may be exposed to trauma through events that threaten their safety, stories of traumatic experiences of others, institutional discrimination, and the collective trauma of their community and ancestors. Members of different racial, ethnic, religious, and other marginalized groups may carry the traumatized experiences of their ancestors and communities.

• Everyone copes with trauma differently and trauma often overwhelms the body's ability to cope. Individuals may develop coping mechanisms that feel good in the moment but are less healthy long term, such as substance use, avoidance, self-harm, over or under eating, and gambling.

• Without a trauma-informed approach, service delivery can be retraumatizing for individuals. For example, individuals may be required to tell their story multiple times, they may fear or even face discrimination, they may be made to feel like just a number, or they may be labeled "difficult", "problematic", or "non-compliant" due to their trauma response and coping mechanisms.

• Trauma-informed, person-centered care fully integrates a knowledge of trauma into all policies and procedures. Examples of this in practice include minimizing barriers to accessing services, creating a welcoming physical environment, informed consent for all services, working to minimize power imbalances and using person-first language.

Additional Resources:

• 'Aging with a History of Trauma' by the Center for Aging, Trauma, and Holocaust Survivor Care

• Substance Abuse and Mental Health Services Administration

• Crisis Prevention Institute