Turnbull, Sue

Birch, Lucy

Matupi, Esther

2024-10-09T09:39:17Z

2024-10-09T09:39:17Z

2024-10-09

BACKGROUND: It is estimated that between 50 and 90% of older adults have been exposed to at least one type of potentially traumatic event. In older adults, trauma is associated with worse cognitive, physical and social functioning and elevated rates of mental health difficulties and substance use disorders, as well as increased risk for suicidal ideation and attempts. There is a large body of evidence available concerning the psychometric properties and utility of Posttraumatic Stress Disorder (PTSD) screening instruments for the general adult population, but their validity and reliability in the older adult population is still undetermined. Research suggests the identification of PTSD in older adults has specific challenges, causing a higher frequency of under-detection of trauma-related symptoms within this population. Trauma informed Practice (TIP) has been found to support recovery from mental health difficulties and improve people's experiences of care within healthcare services. However, the conceptualisation and implementation of TIP among healthcare professionals working in older adult services remains largely under-studied. OBJECTIVES: Chapter 1 of this paper reviewed the relevant literature on screening instruments used to detect Posttraumatic stress disorder (PTSD) in older people in order to identify appropriate tools and cut-off scores with optimal performance based on sensitivity and specificity. Chapter 2 aimed to understand how healthcare professionals in older adult mental health services approach TIP, and the barriers to and facilitators of this. METHOD: A systematic review of studies assessing the use of PTSD screening instruments in the older adult population was completed using an electronic search to apply key search terms. Selection and assessment of articles was conducted by following a structured approach and utilising predetermined quality criteria. A Constructivist Grounded Theory approach was used to carry out 16 in-depth interviews with staff members working within older adult mental health services about their experiences of working with people who have experienced trauma and providing trauma informed care. Data were analysed in an iterative process to construct a model grounded in the data. RESULTS: The systematic review identified 10 studies which satisfied the inclusion criteria. There was significant heterogeneity of screening instruments across studies. A key finding was the paucity of research in this area and that there is a need for further research identifying the validity and reliability of screening tools based on the PTSD criteria in the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-V). From the studies that were available, the screening instrument most frequently studied was the Posttraumatic Stress Checklist (PCL) (based on DSM-IV), which was found to be valid within the population. The findings suggest that for the PCL a cut-off score in the mid thirties is most appropriate. The conceptual model developed reflected staff members’ beliefs that “choice and power” are central elements to being trauma informed in older adult community mental health services. Staff perceived a unique element of working within older adult services was “hidden trauma” which identified a high level of previously undisclosed trauma in clients. The model established the core factors that were perceived to facilitate choice and power within services were care and compassion, prioritising staff wellbeing, promoting team connections and collaboration, and facilitating continuous learning. There was a complex relationship between client cognitive impairment and choice and power. System pressures were perceived by staff members to be a barrier to TIP. CONCLUSION: Further research is required into the screening instrument which would be best fit for use in the older adult population and particularly exploring the use of screening instruments that reflect DSM-V criteria. The conceptual model highlighted important considerations for TIP within older adult mental health services and provided suggestions for future research and service implementation.

https://hdl.handle.net/1842/42274

http://dx.doi.org/10.7488/era/4994

en

The University of Edinburgh

psychological trauma

psychological trauma in older people

Posttraumatic Stress Disorder Checklist

Trauma Informed Practice

sharing trauma

Psychological trauma in older adult services: post-traumatic stress disorder (PTSD) screening and conceptualisation of trauma informed practice

Thesis or Dissertation

Doctoral

DClinPsychol Doctorate in Clinical Psychology