Impact and Needs in Caregiving for Individuals With Dementia and Comorbid Posttraumatic Stress Disorder Living in Nursing Homes

Abstract

Exposure to potential traumatic events (PTE) can result in long-lasting psychological disorders, such as posttraumatic stress disorder (PTSD). Most knowledge about PTSD is based on research on adults in specific survivor groups, including veterans and women who were in abusive relationships. In later life, cognitive and functional decline can make it harder to cope with PTE, resulting in delayed-onset PTSD symptoms.

There is limited information about the prevalence of PTSD in individuals with dementia, but recent research suggests it to be between 4.7% and 7.8% (Sobczak et al. 2021). It is difficult to diagnose PTSD in this population due to a lack of appropriate tools (Havermans et al. 2023). As the global dementia population triples by 2050, there is a critical need to improve the identification and treatment of PTSD in individuals with dementia.

The clinical manifestation of PTSD in individuals with dementia may differ from those without dementia (van Dongen et al. 2022). PTSD symptoms can be difficult to distinguish from neuropsychiatric symptoms. For example, it is possible that ‘screaming’ is a fear response to a flashback that the individual is experiencing and, thus, a potential PTSD symptom. Another example is ‘resistance against caregivers’ due to a history of violence or sexual abuse, and ‘wandering’ as a form of avoidance behaviour. Earlier research showed that the DSM-5 PTSD symptoms of re-experiencing, anxiety and sleep disturbances are commonly reported in individuals with dementia, while avoidance behaviour was less commonly seen (Amano and Toichi 2014; Martinez-Clavera et al. 2017). This difference in clinical manifestation could lead to misinterpretation and misdiagnosis, potentially resulting in ineffective treatment.

Let us remember that nursing staff are facing challenges with individuals who suffer from PTE-related neuropsychiatric symptoms. It is time to improve trauma-sensitive care for these individuals. This can be achieved by: recognising possible PTSD, improving treatment and personalising an approach. The ultimate goal is to improve quality of life for people who have PTE-related symptoms in dementia. This approach will definitely promote staff and patient safety.

Demi C.D. Havermans: conceptualization, methodology, writing – original draft preparation. Monica Cations: writing – original draft preparation, writing – reviewing and editing. Jelte S. Woudsma: writing – original draft preparation, writing – reviewing and editing. Isabelle Janssen: writing – reviewing and editing. Janine Collet: writing – reviewing and editing. Debby L. Gerritsen: writing – reviewing and editing. Chris M. Hoeboer: methodology, supervision, writing – reviewing and editing. Miranda Olff: methodology, supervision, writing – reviewing and editing. Sjacko Sobczak: methodology, supervision, writing – reviewing and editing.

The authors declare no conflicts of interest.