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Design and Participants: This study (using national Health and Retirement Study data [HRS, 2006-2020]) determined the prevalence of early-life and cumulative trauma among persons at end of life by gender and birth cohort, and the association of lifetime trauma with end-of-life physical, mental, and social well-being. Birth cohorts were: born <1924; depression children (1924-1930); HRS cohort (1931-1941); war babies (1942-1947); early baby boomers (1948-1953); and mid baby boomers (1954-1959). An 11-item traumatic events scale (cumulative trauma: 0-5+ lifespan events) measured events, and end-of-life outcomes included measures of physical (pain, fatigue, dyspnea), mental (depression, life satisfaction), and social (loneliness, isolation) needs. Multivariable logistic regression reported the prevalence of trauma by gender and birth cohort and the adjusted probability of each end-of-life outcome by trauma.
Results: Participants (N=6,495) were aged mean 78 years (SD=11); 52% female; and 83% non-Hispanic White, 9% non-Hispanic Black, and 5% Hispanic. Lifetime trauma was common (0 events: 19%; 1-2: 47%; 3-4: 25%; 5+: 9%), with variation in individual events (P<.001: death of a child [women: 24% vs men: 18%], weapons in combat [1% vs 23%]) by gender and birth cohort. Increasing cumulative trauma was associated (P<.001) with higher reports of end-of-life moderate-to-severe pain (0 events: 46%; 1-2 events: 50%; 3-4 events: 57%; 5+ events: 60%), fatigue (58%; 60%; 66%; 69%), dyspnea (46%; 51%; 56%; 58%), depression (24%; 33%; 37%; 40%), and loneliness (12%; 17%; 19%; 22%), and lower life satisfaction (73%; 63%; 58%; 54%).
Commentary: Palliative care clinicians embody a holistic approach to care that strives to address total suffering of patients at the end of life. Knowing a patient’s trauma history deepens our understanding of how patients experience psychological and symptom burdens at the end of life. This study describes how trauma is highly prevalent in older adults and hypothesizes how this can lead to worse mental health, well-being, and symptoms, particularly in the last 4 years of life. The findings suggest that providing presumptive trauma-informed care to older adults can improve quality of life. This study adds to the growing body of literature that supports integrating trauma-informed practices into the holistic care that palliative care practitioners have already promised to provide for our patients.
Bottom Line: It is incumbent on palliative care clinicians to integrate trauma-informed practices to address the needs of patients who experience greater symptoms and psychological burden at end of life secondary to multiple traumatic life events.
Reviewer: Arshia Madni, MD FAAP, University of Tennessee Health Science Center/Le Bonheur Children’s Hospital, Memphis, TN
References:
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2. Ganzel BL. Trauma-informed hospice and palliative care. Gerontologist. 2018;58(3):409-419. doi:10.1093/geront/gnw146.
3. Brown CK, DiBiase J, Nathanson A, Cadet TJ. Trauma informed care for inpatient palliative care social work: applying existing models at the bedside. J Soc Work End Life Palliat Care. 2023;19(4):309-325. doi:10.1080/15524256.2023.2256479.
Source: Duchowny KA, Smith AK, Cenzer I, et al. The prevalence of lifetime trauma and association with physical and psychosocial health among adults at the end of life [online ahead of print October 1, 2024]. J Am Geriatr Soc. doi:10.1111/jgs.19209.
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