Duchowny Kate A, Smith Alexander K, Cenzer Irena, Brown Chelsea, Noppert Grace, Yaffe Kristine, Byers Amy L, Perissinotto Carla, Kotwal Ashwin A
Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA.
Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
J Am Geriatr Soc. 2025 Jan;73(1):123-135. doi: 10.1111/jgs.19209. Epub 2024 Oct 1.
National guidelines recognize lifetime trauma as relevant to clinical care for adults nearing the end of life. We determined the prevalence of early life and cumulative trauma among persons at the end of life by gender and birth cohort, and the association of lifetime trauma with end-of-life physical, mental, and social well-being.
We used nationally representative Health and Retirement Study data (2006-2020), including adults age > 50 who died while enrolled (N = 6495). Early life and cumulative traumatic events were measured using an 11-item traumatic events scale (cumulative trauma: 0-5+ events over the lifespan). We included six birth cohorts (born <1924; children of depression [1924-1930]; HRS cohort [1931-1941]; war babies [1942-1947]; early baby-boomers [1948-1953]; mid-baby boomers [1954-1959]). End-of-life outcomes included validated measures of physical (pain, fatigue, dyspnea), mental (depression, life satisfaction), and social (loneliness, social isolation) needs. We report the prevalence of lifetime trauma by gender and birth cohort and the adjusted probability of each end-of-life outcome by trauma using multivariable logistic regression.
The mean age at death was 78 years (SD = 11.1) and 52% were female. Lifetime trauma was common (0 events: 19%; 1-2: 47%; 3-4: 25%; 5+: 9%), with variation in individual events (e.g., death of a child, weapons in combat) by gender and birth cohort. After adjustment, increasing cumulative trauma was significantly associated (p-value<0.001) 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%), loneliness (12%; 17%; 19%; 22%), and lower life satisfaction (73%; 63%; 58%; 54%).
Older adults in the last years of life report a high prevalence of lifetime traumatic events which are associated with worse end-of-life physical and psychosocial health. A trauma-informed approach to end-of-life care and management of physical and psychosocial needs may improve a patient's quality of life.
国家指南认为终生创伤与临终成年人的临床护理相关。我们按性别和出生队列确定了临终者早年及累积创伤的患病率，以及终生创伤与临终时身体、心理和社会福祉的关联。
我们使用了具有全国代表性的健康与退休研究数据（2006 - 2020年），包括年龄大于50岁且在入组期间死亡的成年人（N = 6495）。早年及累积创伤事件通过一个包含11项的创伤事件量表进行测量（累积创伤：一生中0 - 5起及以上事件）。我们纳入了六个出生队列（出生于1924年以前；大萧条时期出生的孩子[1924 - 1930年]；健康与退休研究队列[1931 - 1941年]；战时出生者[1942 - 1947年]；早期婴儿潮一代[1948 - 1953年]；中期婴儿潮一代[1954 - 1959年]）。临终结局包括经过验证的身体（疼痛、疲劳、呼吸困难）、心理（抑郁、生活满意度）和社会（孤独感、社会孤立）需求的测量指标。我们报告按性别和出生队列划分的终生创伤患病率，以及使用多变量逻辑回归分析得出的每种临终结局因创伤调整后的概率。
死亡时的平均年龄为78岁（标准差 = 11.1），52%为女性。终生创伤很常见（0起事件：19%；1 - 2起：4%；3 - 4起：25%；5起及以上：9%），不同性别和出生队列的个别事件（如孩子死亡、战斗中接触武器）存在差异。调整后，累积创伤增加与临终时中重度疼痛（0起事件：46%；1 - 2起事件：50%；3 - 4起事件：57%；5起及以上事件：60%）、疲劳（58%；60%；66%；69%）、呼吸困难（46%；51%；56%；58%）、抑郁（24%；33%；37%；40%）、孤独感（12%；17%；19%；22%）报告率较高以及生活满意度较低（73%；63%；58%；54%）显著相关（p值<0.001）。
处于生命最后几年的老年人报告终生创伤事件的患病率很高，这些创伤与更差的临终身体和心理社会健康状况相关。一种考虑创伤因素的临终护理及身体和心理社会需求管理方法可能会改善患者的生活质量。
