"We found that early-life trauma in particular, especially physical abuse by parents, was strongly related to end-of-life pain, loneliness and depressive symptoms," said Dr. Ashwin Kotwal of the UCSF Division of Geriatrics and the San Francisco VA Medical Center. The study highlights how traumatic events may contribute to social and emotional isolation, as well as poor health habits that increase the risk of further trauma.
This research, derived from the Health and Retirement Study (HRS), tracked 6,500 Americans over the age of 50 from 2006 to 2020. Published on October 1 in the 'Journal of the American Geriatrics Society', the study suggests that trauma has a "lifelong impact," according to co-author Kate Duchowny, PhD, MPH, of the Institute for Social Research at the University of Michigan. "We know that trauma is associated with depression and anxiety, which may promote a pro-inflammatory environment that is associated with chronic conditions. If stress is persistent, it can lead to inflammation and adverse health consequences in later life."
Participants were surveyed about 11 traumatic events and their mental health, with the final "exit interview" conducted by family members or those with power of attorney. The study revealed that the most common childhood trauma was repeating a school year, while adult traumas often included battling life-threatening illnesses or having a spouse or child with such illnesses.
Findings showed that 80% of participants experienced at least one lifetime trauma, and one-third experienced three or more. Those with no traumatic history had lower chances of pain or loneliness near the end of life, with a 46% likelihood of moderate-to-severe pain and a 12% likelihood of loneliness. In contrast, participants with five or more traumatic events had a 60% probability of experiencing pain and a 22% likelihood of loneliness.
Depression rates were similarly stark, with trauma-free participants having a 24% probability of end-of-life depression, compared to 40% for those who endured five or more traumatic events.
Dr. Kotwal emphasized the need for a trauma-informed approach to patient care at the end of life. "Near the end of their lives, people may experience 'total pain'-pain that may be spiritual and psychological, as well as pain from physical sources. Lifetime trauma may shape that total experience of pain," he explained. He also noted that connecting patients with psychologists, chaplains, or social workers may alleviate their suffering.
Co-author Chelsea K. Brown, a former UCSF social worker, added that trauma survivors may experience a painful loss of control as they near death. "For a person who has also experienced trauma, this loss of control may serve as a reminder of previous harmful experiences, and this is painful to relive in so many ways," Brown noted.
Research Report:The prevalence of lifetime trauma and association with physical and psychosocial health among adults at the end of life
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