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September/October 2024
September/October 2024 Issue The Last Word: Treating Trauma at Life’s End One thing we do well as hospice and palliative care providers is ensuring that people die well in a manner and place of their choosing—most often in the comfort of their homes. We take care of a person’s whole being, not only addressing their physical health but also ensuring their emotional, mental, and spiritual wellbeing are nurtured. Thus, we’re uniquely positioned to care for those who suffer from an often-hidden epidemic—trauma from the effects of domestic violence, sexual assault, elder abuse, and neglect. Many of our older patients come from a generation we refer to as the silent generation, for whom reporting or talking about abuse is still seen as shameful. Victims may keep their abuse a secret to protect themselves from shame, embarrassment, and even unjust blame. However, silence does not negate the existence of trauma. Where society may overlook abuse against older people, geriatricians and those who care for older patients not only can recognize these issues exist but also treat and tackle them. Based on these realities, medical providers should operate under the assumption that they care for a significant number of patients who have been victims of abuse at some stage of life. We need to be extra vigilant because, in many cases, we provide care in the home rather than in a hospital facility, creating opportunities for domestic violence and abuse to go unnoticed. Health care providers are becoming increasingly aware of this issue, but there’s still much work to be done. Some Action Points We Can Implement • Adopt trauma-informed care approaches: Embrace trauma-informed care practices that acknowledge the widespread prevalence and profound impact of abuse on patients. Create environments that prioritize safety, trust, and empowerment, ensuring patients feel secure and supported throughout their care journey. • Establish open communication: Foster workplaces where open, nonjudgmental communication with patients is encouraged. Train staff to create environments where patients feel comfortable disclosing their experiences, knowing they will be heard with compassion and respect. • Use screening tools: Implement standardized screening tools to inquire sensitively about patients’ personal relationships and safety at home. Regularly assess and document findings to ensure thorough and ongoing evaluation of patient well-being. • Improve care planning: Educate family members and caregivers about recognizing and responding to signs of abuse. Ensure robust documentation and reporting protocols are in place to track and address concerns effectively. We must unravel deep-rooted societal taboos about speaking out and remove the judgment of the victim. We must never blame the victim—this is not their fault. Trust them and help them feel heard. There are also many perceptions about domestic violence that need to be challenged. The notion that a victim can just leave is not accurate. Abusers often make their victims feel they cannot function in the world without them. For geriatricians, understanding and addressing trauma from past and present abuse is crucial. By adopting comprehensive care strategies that incorporate trauma-informed approaches, medical providers can play a pivotal role in ensuring that their patients’ final days are filled with dignity, respect, and peace. This holistic approach not only benefits the patients but also supports their families and caregivers, creating a more compassionate and effective health care system for all. — Carol Fisher is president of the National Partnership for Healthcare and Hospice Innovation; global ambassador for NO MORE, a global antidomestic violence movement; and former host of the globally acclaimed podcast, The Girlfriends, which explores themes of abuse and domestic violence. |
