1. Sirkka Perttu MSc, Health Care; RN Tartu 31 August 2017
Elder Abuse as a Challenge in Social Services – Complex/Cumulative and Historical trauma
Sirkka Perttu
MSc, Health Care; RN
Tartu 31 August 2017

2. Complex/Cumulative trauma
a type of trauma that occurs repeatedly and cumulatively, usually over a period of time and within specific relationships and contexts
Child abuse, intimate partner/domestic violence
events and experiences are:
repetitive, prolonged, or cumulative
most often interpersonal, involving direct harm and exploitation, including neglect/abandonment by close person(s)
often occur at developmentally vulnerable times in the victim's life, especially
in childhood or adolescence, or later in life and in conditions of vulnerability associated with disability/ disempowerment/dependency/age
31/08/2017
Sirkka Perttu

3. Complex/cumulative trauma
Cumulative trauma experiences can become as a way to feel everyday life where ever she/he goes (Ogle Christin M, Rubin David C and Siegler Ilene C Cumulative exposure to traumatic events in older adults. Aging Menatl Health 2014 Apr; 18 (3): )
Complex trauma – complex symptoms
Difficulties to regulate affective impulses (anger, self-destructiveness)
Dissociative episodes/psychotic episodes/psychiatric illness/psychogenic amnesia
Difficulty trusting people or feeling intimate
Hopelessness or despair
Feeling of permanent damage
Chronic sense of guilt and Responsibility
Intense shame / Stigmatization
Nobody can understand
Toni Luxenberg et al. 2001; Firestone Lisa Recognizing Complex Trauma. Psychology Today.
31/08/2017
Sirkka Perttu

4. Complex/cumulative trauma
Long-term effects of abuse include: permanent physical damage, chronic eating disorders, disability, self-harm, self-neglect, loss of confidence and mental health problems
The effects are likely to be more severe and serious for older women, due to the possibly long-term abuse, and increased frailty.
Jackie Barron Older women and domestic violence, An Overview. Women’s Aid.
Complex trauma leads to loneliness, loss, and intensification of the experience of suffering following children leaving home, mourning and remorse/regret or guilt (Mears 2003; Montminy 2005)
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Sirkka Perttu

5. Complex/Cumulative trauma
Premature mortality in abused older adults: risk of death is three times higher than non-victims
Significant effects on mental health: Lower health status is associated with poorer overall life expectancy and greater health service utilization.
Charles P. Mouton Intimate Partner Violence and Health Status Among Older Women. Violence Against Women, Vol. 9 No. 12, December 2003 , pp
Somatic or medical problems
Digestive System
Chronic Pain
(Firestone Lisa Recognizing Complex Trauma. Psychology Today.)
31/08/2017
Sirkka Perttu

6. Historical or intergenerational trauma
cumulative emotional and psychological damage can extends across generations
If trauma is not dealt adequately in one generation, it is often transferred to following generations unknowingly influencing behaviours and thought systems
to break the cycle the trauma has to be healed
Ogle Christin M, Rubin David C and Siegler Ilene C Cumulative exposure to traumatic events in older adults. Aging Menatl Health 2014 Apr; 18 (3):
31/08/2017
Sirkka Perttu

7. Transgenerational war traumas Helakallio-Ranta, Päivi 2017
Transgenerational war traumas Helakallio-Ranta, Päivi Sodan pitkät jäljet: Ylisukupolviset sotatraumat.
The data was collected through individual and group interviews in The respondents consisted of four three-generation chains that were interviewed to discover transgenerational traumas.
Parents’ war traumas have affected the next generations’ lives and life choices.
First and second generations of the respondents had not been able or willing to seek help because they thought it was shameful.
Life was considered hard and, according to the respondents, one just had to stand patiently and struggle.
The second generation of the respondents felt that their parents had left them completely alone.
They felt they had been neglected
The second generation had a lot of problems with their psyche and they were not happy with their relationships.
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Sirkka Perttu

8. Transgenerational war traumas
The third generation of the respondents had sought help for their unclear symptoms that they did not know how to put into words.
They had difficulties to find a suitable field of studies and they had also had relationship problems.
The third generation of the interviewees had felt enormously affected by their parents’ inability to discuss problems at home.
31/08/2017
Sirkka Perttu

9. Posttraumatic Stress Disorder (PTSD) in older persons
= Long-term effect/consequence
Insomnia
Lack of sleep can exacerbate other symptoms of PTSD
Nightmares, difficulty initiating sleep, and frequent awakenings
Avoidance
Re-experiencing (can also face of re-awakened memories of traumatic experiences happened in the past)
Psychotic symptoms associated with PTSD
Kaiser Anica Pless, Wachen Jennifer Schuster, Potter Carrie, Moye Jennifer & Davison Eve The Stress, Health, and Aging Research Program (SHARP). Posttraumatic Stress Symptoms among Older Adults: A Review.
31/08/2017
Sirkka Perttu

10. Posttraumatic Stress Disorder (PTSD) and Aging
PTSD can change the personality
Impact of trauma is even more severe when it is deliberately inflicted by another person
Symptoms of PTSD can increase with age
Role changes and functional losses may make coping with memories of earlier trauma more challenging for the older adult
retirement, increased health problems, reduced income, loss of loved ones, decreased social support, cognitive impairment, functional decline.
To manage posttraumatic stress symptoms in early and mid-life, individuals may engage in avoidance-based coping strategies
E.g. alcohol problems
At the same time, adaptation and resilience (recover quickly from difficulties, flexibility) developed over a lifetime can provide a rich reservoir of coping resources
Kaiser Anica Pless, Wachen Jennifer Schuster, Potter Carrie, Moye Jennifer & Davison Eve. The Stress, Health, and Aging Research Program (SHARP). Posttraumatic Stress Symptoms among Older Adults: A Review.
31/08/2017
Sirkka Perttu

11. Posttraumatic Stress Disorder (PTSD) and Aging
PTSD may manifest differently in older adulthood, as indicated by more frequent reports of poor health, chronic pain, and cognitive impairment among older compared to younger adults with trauma histories
the relation between cumulative trauma exposure and post-traumatic outcomes may become more complex with age
Ogle Christin M, Rubin David C and Siegler Ilene C Cumulative exposure to traumatic events in older adults. Aging Menatl Health 2014 Apr; 18 (3):
31/08/2017
Sirkka Perttu