Robert, an elderly man with dementia, lived in an apartment with his partner and caregiver, Rosie, who helped him with daily tasks, such as cooking dinner or moving from his bed to a wheelchair. Then Robert suddenly fell after dinner one evening. His doctors determined it was no longer safe for him to live independently with Rosie and that he needed a higher level of care.
Although the transition to a senior care facility was necessary, the sudden change in environment, structure and routine was disruptive to Robert and his condition. His dementia impeded his ability to understand or adjust to the changes, and his dementia-related symptoms worsened.
This is a common scenario, says Rebecca Jackson Stoeckle, a Massachusetts-based vice president at the Education Development Center and director and principal investigator of the National Collaboratory to Address Elder Mistreatment.
Moving is inherently stressful for anyone, but transferring between levels of care or various facilities can be even more distressing for older adults. This stress is known as transfer trauma, relocation stress syndrome, moving anxiety, relocation anxiety syndrome or elder transfer trauma.
What Is Transfer Trauma?
Transfer trauma, according to NANDA International (formerly the North American Nursing Diagnosis Association), is “a condition characterized by a range of symptoms that occur due to the changes and anxieties associated with the relocation process.”
These symptoms include:
— Confusion.
— Hopelessness.
— Restlessness.
— Fatigue.
— Inability to focus.
— Poor hygiene.
— Changes in eating and sleeping habits.
— Increased susceptibility to physical health conditions.
Diagnosing transfer trauma, however, can get a little murky. NANDA International, for instance, considers transfer trauma an official nursing diagnosis and a type of post-trauma response. This classification matters. A nursing diagnosis allows nurses to create a patient plan of care around the condition; perform nursing interventions, such as creating a plan to reduce anxious thoughts; and evaluate the patient specifically in regard to transfer trauma.
Yet, transfer trauma is not an official medical diagnosis, though physicians can treat it as a type of adjustment disorder. Adjustment disorders, according to the Mayo Clinic, are outsized, intense physical and emotional reactions to stress.
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Who Is at Risk for Transfer Trauma?
Transfer trauma can happen to all adults moving between care facilities, as moving is often a stress-inducing event.
Dr. Gary Small, chair of psychiatry at Hackensack University Medical Center in New Jersey, says that some individuals may be more at risk for transfer trauma. They include:
— Residents of long-term care facilities.
— Individuals with cognitive impairments, such as Alzheimer’s disease.
— Those with little or no family support system.
Nearly half of long-term care residents have a cognitive impairment, adds Small, who also serves as a behavioral health physician-in-chief and the Hovnanian Family Foundation Endowed Chair in Behavioral Health for Hackensack Meridian Health.
In fact, 49% of nursing home residents have Alzheimer’s disease or other dementias, notes the Alzheimer’s Association. Essentially, having any kind of cognitive impairment makes adjusting to a new environment that much harder.
[READ: When to Consider Moving to a Senior Care Facility]
How Long Does Transfer Trauma Last?
Transfer trauma affects each senior differently, depending on their experiences, coping skills and health status. A 2019 study published in Aging and Mental Health, for instance, suggests that how the senior interprets the transfer — as a harm, loss, challenge or threat — shapes their response.
Cognitively impaired adults have more difficulty coping with a move, the study reiterates. Plus, the researchers suggest that relocation stress should be considered a risk factor for depression within the first year after relocation.
“Residents also go through a grieving process of missing their more familiar home, and such grief can worsen mental symptoms,” Small adds.
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Ways to Treat Transfer Trauma
Transfer trauma may not be completely preventable because many are medically necessary and each adult responds to change in a different way.
Fortunately, there are various state and federal mandates to minimize transfer trauma, Small says. For example, these mandates include providing sufficient preparation and orientation to residents transferring or discharged from a facility as well as preventing evictions of nursing home residents.
Other strategies to mitigate the impact include:
— Communicating clearly.
— Encouraging residents to participate in activities.
— Orienting residents to their new space.
— Allowing as much autonomy as possible.
Communicating clearly
Group meetings with the care team — both at a resident’s current community and their future one — are key to helping everyone know what to anticipate.
“Open communication back and forth during the first couple of weeks in a senior community is critical to the resident adjusting well to the new environment and enjoying their experience,” explains Sue Johansen, a San Francisco-based executive vice president with A Place for Mom, a senior advisory service.
Communication needs depend on the cognitive ability and personality of the resident, but it’s important to talk about the need for a move, changes in daily routines and how the senior feels about the move.
In some cases, the senior may not be interested in discussing the emotional changes that come with relocating. However, it’s still essential to keep them updated on their daily schedule, introduce them to new staff and allow them to make personal decisions, like what to wear or how to decorate their room.
If you or a loved one is experiencing transfer trauma, talk with the new staff, especially a supervisor or nurse, to ensure that symptoms are addressed. You can also request that coping with relocation stress is made part of the care plan.
Encouraging residents to participate in activities
Everyone, even residents with dementia, benefit from some type of mental stimulation. Johansen says that assisting living communities provide a variety of activities so older adults can get involved in their community and adjust to their new environment. Activities that promote individuality, like scrapbooking or documenting past life experiences, can be particularly helpful for the adjusting resident.
“Many communities will assign a resident a ‘mentor’ to welcome the new resident into the community,” Johansen says, adding that these mentors can help ensure a successful transition.
Orienting residents to their new space
Visiting a new residence in advance can help to reduce anxieties about the move and make the unfamiliar a little less daunting, Small says.
“Moving familiar objects, photos, furniture and décor can help make the new setting comfortable and less threatening,” he adds.
Once you’re settled in, having visits from familiar faces also helps.
Allowing as much autonomy as possible
Ensuring that residents feel a sense of empowerment and control can ease the move from independent to assisted living, for instance, or assisted living to memory care.
“It’s crucial for staff and loved ones to allow (residents) to make decisions regarding their personal space, clothing selection, meal preferences and other areas of their lives,” Johansen explains.
That ability to choose, coupled with activities they love, can set both residents and loved ones on the path to feeling happier and more secure.
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What Is Transfer Trauma? originally appeared on usnews.com
Update 09/13/23: This story was previously published at an earlier date and has been updated with new information.
