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 – OABHI@clackamas.us

Multnomah – OABHI@multco.us

Washington – OABH@co.washington.or.us