Dr. Regina Koepp: can we treat PTSD among people living with dementia? In this video I'm gonna talk about considerations for trauma treatment among people living with dementia disorders.

What qualifies me to talk about this? I'm Dr. Regina Koepp. I'm a board certified clinical psychologist and Geropsychologist and founder of the Center for Mental Health and Aging. A large portion of my career has been working with people with cognitive impairment and dementia disorders and history of trauma in my work at the Atlanta VA Healthcare system, where I worked as psychologist on an outpatient Geropsychiatry team.

And so a lot of the patients that I provided psychotherapy and family therapy to, were living with both cognitive impairment and post-traumatic stress disorder. So today I'm gonna share a little bit about the what the National Center for PTSD says, and then some of my clinical experience, and then also special considerations and unique considerations that we need to take into account when providing care to people with dementia who have a trauma history.

If you'd like to learn more about trauma-informed care with older adults, I have a free guide for professionals. It's at mentalhealthandaging.com/tic for trauma-informed care.

So does treatment for trauma work when people have dementia? And the answer is maybe, first we have to look at the stage of dementia that the person has.

So in the earlier stages of dementia, when the person is functioning independently, has emotion regulation, ability, has impulse control, ability, yes. Likely.

The national research that the National Center for PTSD talks about, that looks at prolonged exposure in folks with dementia and also prolonged exposure in folks with traumatic brain injury.

And especially in the early stages of a dementia disorder, it is quite possible that the person can benefit from trauma treatment. This needs to be done with the utmost care and consideration, and I would say consultation with a Geropsychologist or a person who specializes in older adults to, if you're a trauma therapist, to, to navigate that.

And the reason is because there comes a point in the disease process with a dementia disorder. That it may be difficult for the person to manage their impulses and regulate their emotions. And so when you're doing trauma work, you may be eliciting a lot of emotionality and memories, and these memories may be lasting, especially if they're remote traumatic events.

Those memories may be able to be recalled and the emotions that come with them may be able to be recalled, however. You might not be able to do the true trauma work of helping the person to regulate their emotions, manage their impulses, and reduce the intensity of those emotions related to those memories, because of the brain disease. And so when that's happening, you really have to be conscientious when you're working with a person with dementia and doing trauma treatment about what their brain is capable of at this stage. And it is constantly changing. So that's a word of advice and caution and care for you to consider.

Say that now that the dementia is progressing and the person is in moderate or later stages of the disease and they have a trauma history and they live in memory care or in their home, sometimes behavioral disturbances that we see, like agitation or anxiety or pacing might be a result of trauma memories that we just don't know.

And so when you're doing an intake with somebody, it will be helpful if you're consulting with the family about this to understand does the person have a trauma history? So then you can modify the environment so often. When you can't do the deep psychotherapeutic work like you would do, now the intervention becomes that we modify the environment to reduce trauma triggers.

Trauma triggers are very unique to the person. People can experience the same traumatic event and have very different trauma triggers associated with that traumatic event. So like a person gets in a car accident and one person may have a trauma trigger of sitting in the car or buckling a seatbelt and hearing the buckle of the seatbelt.

Whereas another person who'd been in a car accident may have the trauma trigger of the smell of burning oil because there was a fire with the car accident. And so each person will have their unique trauma triggers. And so it is really important as you're getting to know the person that you are caring for with dementia, that you understand their trauma history and what their unique trauma triggers are so that you can modify the environment to reduce any interaction with those trauma triggers.

So some common trauma triggers are violent TV programs or or movies about war, or news coverage of traumatic events or fires or things like that from natural disasters to wars. For some people living with dementia, being bathed can be a trauma trigger, especially if there's a history of sexual assault or having a certain gender of a caregiver can be triggering, especially in the history of abuse or violence or in intimate trauma.

Certain smells can be very triggering to people like foods or flesh or wounds or fire. Certain sounds can be triggering like loud noises. Often people with a trauma history or PTSD have a startle response to loud sounds. Walking behind and approaching a person from behind can be very triggering for somebody.

And then perceived threats or physical touch can also be very triggering to folks with a history of trauma.

And so as I've mentioned that you want to really be curious when you're doing an intake with a person, especially if they're moving into memory care or you're helping family navigate trauma triggers at home, be very clear.

What were the triggers preceding the dementia disorder? So you have a sense of what to be looking out for. And then how did they respond to the trauma triggers in the past? And then if a person with dementia is triggered, then helping with deescalation could be very helpful. And of course, with deescalation when the person is triggered, when a person's living with dementia. It's harder for them to regulate their own emotions and to manage their own impulses with the triggers.

And so I have worked with veterans who are living in memory care and a fire alarm in the memory care goes off and the person becomes difficult to get outside as you would with a a fire protocol to get people outside and safe because they're in this fight or flight situation and they're not fleeing, they're like resistant to going because they're triggered and scared and it can be really complicated in memory care or in a home to navigate this. And so the more that you understand that person, the more that you understand how to deescalate that individual, the more you're able to work with family to understand them, the better.

What's so tricky is memory care tends to be understaffed and undertrained to meet some of the mental health needs of people living with dementia.

And please find yourself consultants and guidance on navigating mental health concerns in the context of dementia. Because what I have seen time and time again, which is tragic and discouraging is that when there are situations like this, like the person that I mentioned that the veteran I had who there was a fire alarm and he refused to leave the building 'cause he was scared and on lockdown himself.

They said that he needed to move after that incident because they didn't feel like they were equipped to care for him. I just wanna encourage folks, please do not move people because they are agitated or resistant. More than 95% of people living with dementia have neuropsychiatric symptoms, and so it is not an exception.

It is an expectation that people will have mental health symptoms related to dementia. If you're providing dementia care, you need to be equipped to help navigate some of the mental health concerns. And sometimes it takes time for that person to deescalate, their brain has a disease and they need coaching and help and patience and grace, and please, let's get away from this culture of moving people who are agitated out of memory care and instead make sure that staff get training to address the needs properly.

If you found this mental health and aging tip helpful, will you subscribe and leave a review and share it so other people will find this information. My goal is to make sure that you have the tools that you need to meet mental health needs of older adults. Because as you see, older adults are largely left out of mental health care, including adults with dementia disorders and it is only with your help that we will create this movement to ensure that older adults get high quality mental health care just like everybody else. So thank you for being here and doing your part. I'll see you next week.

Bye for now.