养老院入院者既往创伤的关注：722 例入院者筛查报告。

Concern About Past Trauma Among Nursing Home Admissions: Report From Screening 722 Admissions.

机构信息

Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.

Emory Healthcare, Atlanta, GA, USA.

出版信息

J Am Med Dir Assoc. 2022 Sep;23(9):1499-1502. doi: 10.1016/j.jamda.2022.06.011.

DOI:10.1016/j.jamda.2022.06.011

PMID:36087958

Abstract

OBJECTIVE

Major life changes can trigger a traumatic stress response in older adults causing trauma symptoms to resurface. In 2019, the Centers for Medicare and Medicaid Services released the requirement, without specific guidance, for trauma-informed care (TIC) as part of person-centered care in long-term care.

DESIGN

Observational, cross-sectional.

SETTING AND PARTICIPANTS

A total of 722 new admissions at one nursing home in metro Atlanta between November 2019 and July 2021.

METHODS

We developed a "TRAUMA" framework for TIC screening based on Substance Abuse and Mental Health Services Administration resources. The admissions nurse conducted TIC screening within 48 hours of new admissions, including reported trauma and necessary modifications to care plans. Demographic information was derived from electronic records. Analysis included independent sample t-tests, binary logistic regression, and χ tests. All data were analyzed using SPSS v. 28.

RESULTS

Of 722 new admissions, 45 (6.2%) indicated experiencing trauma. There was no significant association with being Black or non-White and experiencing trauma, but there was a significant association with being female and experiencing trauma (χ (1) = 5.206, P = .022). Only men reported child physical abuse and war trauma and only women reported adult sexual assault, child sexual assault, adult domestic violence, school or community violence, adult nonintimate partner violence, and other trauma. There was a small, significant negative association of age and trauma (β = -0.037; SE = 0.11; P < .001). The most-reported trauma category was medical trauma, including COVID-related trauma. More than half (51%) requested spiritual intervention and only 2 requested medical intervention with medication as initial interventions.

CONCLUSIONS AND IMPLICATIONS

Our experience suggests that knowing the patient and their trauma history allowed the admissions nurse and interdisciplinary care team to modify the person-centered care plan to best meet the patient's needs. Our results also emphasize the need for using universal trauma precautions in all interactions.

摘要

目的

重大生活变化可能会引发老年人的创伤性应激反应，导致创伤症状再次出现。2019 年，医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）发布了要求，在长期护理中，将以患者为中心的护理（person-centered care）部分作为创伤知情护理（trauma-informed care，TIC），但没有提供具体指导。

设计

观察性、横断面研究。

地点和参与者

2019 年 11 月至 2021 年 7 月期间，佐治亚州亚特兰大市区一家养老院的 722 名新入院患者。

方法

我们根据物质滥用和心理健康服务管理局（Substance Abuse and Mental Health Services Administration）的资源，为 TIC 筛查制定了一个“TRAUMA”框架。入院护士在新入院后 48 小时内进行 TIC 筛查，包括报告的创伤和必要的护理计划修改。人口统计学信息来自电子记录。分析包括独立样本 t 检验、二元逻辑回归和 χ 检验。所有数据均使用 SPSS v.28 进行分析。

结果

在 722 名新入院患者中，有 45 名（6.2%）表示经历过创伤。经历过创伤与非裔或非白人身份之间没有显著关联，但与女性身份之间存在显著关联（χ（1）= 5.206，P =.022）。只有男性报告了儿童身体虐待和战争创伤，只有女性报告了成人性侵犯、儿童性侵犯、成人家庭暴力、学校或社区暴力、成人非亲密伴侣暴力和其他创伤。年龄与创伤之间存在着较小但显著的负相关（β=-0.037；SE=0.11；P<.001）。报告最多的创伤类别是医疗创伤，包括与 COVID 相关的创伤。超过一半（51%）要求进行精神干预，只有 2 人要求最初通过药物进行医疗干预。