The Prevalence of Lifetime Trauma and Association with Symptom Burden among Adults in the Last Years of Life

Outcomes
1. To describe the prevalence of lifetime trauma among persons in the last years of life and different patterns across gender.
2. To understand the association of lifetime trauma with physical symptoms, mental health, and social needs, and clinical implications for trauma-informed palliative care.
Key Message
Older adults in the last years of life report a high prevalence of lifetime trauma, with different patterns by gender. Collective trauma was associated with worsened end-of-life physical symptoms and psychosocial well-being. Clinicians should adopt a trauma-informed approach to the care of seriously ill adults and consider the impact of past trauma when addressing end-of-life symptoms and psychosocial needs.
Introduction/Context
A better understanding of lifetime experiences of trauma among persons approaching the end of life could guide approaches to trauma-informed palliative care.
Objectives
To determine 1) the prevalence of trauma among persons at the end of life, and 2) the association of lifetime trauma with end-of-life physical, mental, and social well-being.
Methods
We used nationally-representative Health and Retirement Study data, including adults age >50 who died while enrolled (N=4,338). Trauma was measured using a published 11-item traumatic events scale (categorized as 0-5+ events). End-of-life outcomes included validated measures of physical (pain, dyspnea, fatigue), mental (depression, life satisfaction), and social (loneliness, social isolation) needs. We report the overall prevalence of trauma and by gender, then the adjusted probability of each end-of-life outcome by trauma derived from multivariate logistic regression.
Results
The mean age at death was 77 years (SD=11.1), 51% were female, and 83% of respondents reported at least one lifetime traumatic event (0 events: 17%; 1-2: 47%; 3-4: 27%; 5+: 9%). Men most commonly reported having a prior life-threatening illness (49%), a spouse or child having a life-threatening illness (31%), and weapons fired in combat (23%); women most commonly reported prior life-threatening illness (40%), a spouse or child having a life-threatening illness (39%), or a child dying (26%). After adjustment, collective trauma was significantly associated with pain (0 events: 51%; 1-2 events: 52%; 3-4 events: 59%; 5+ events: 59%), dyspnea (50%; 53%; 58%; 64%), depression (23%; 32%; 37%; 42%), life satisfaction (72%; 66%; 60%; 55%), and loneliness (12%; 17%; 19%; 27%), all p< 0.001.
Conclusion
Older adults in the last years of life report a high prevalence of traumatic events which are associated with multiple domains of end-of-life well-being. Clinicians should adopt a universal trauma-informed approach to overall end-of-life care and management of physical and psychosocial needs.