Jennifer Axelson, LCSW, CCM, MSCC, CLCP
Martha Kern

The experience of trauma before, during and after a relocation is so widespread that there are official names for the phenomenon: Transfer Trauma and Relocation Stress Syndrome.  The condition is a variation on adjustment disorder and can be very difficult to endure.

While symptoms of transitional trauma can appear in people of any age undergoing change, particularly when it’s abrupt and unwanted, it is seen most acutely in seniors.

Changes in mood, behavior and physical health can emerge up to three months after a move and are sometimes mistaken for delirium or dementia.

Signs of Trauma

Responses to the upheaval of a move, usually from home to a senior care community, vary from person to person and depend in part on the overall status of the senior being moved.  Frailness and cognitive decline certainly exacerbate the issue, as does moving on the heels of another trauma, such as the loss of a spouse.

When relocating a senior, be watchful for these emotional and behavioral changes:

  • Anxiety
  • Confusion
  • Hopelessness
  • Depression
  • Anger
  • Aggression
  • Agitation
  • Excessive demands for medical attention
  • Isolation
  • Fearfulness
  • Forgetfulness
  • Wandering/attempts to elope

Physical and medical changes are also associated with trauma over transitions, and may include:

  • Falls
  • Weight loss
  • Sleep changes
  • Changes in eating habits

Studies indicate that transferred seniors have higher rates of death than comparable seniors who have not moved, even when the move was merely from one level of care to another within the same facility.

What’s Going On?

Clearly, leaving a long-term familiar environment for a new living arrangement where so much is unknown produces stress.  Compounding this very understandable shock are a host of psychosocial factors related to what it all means.  When a senior undergoes a move or a series of moves, often related to declines in their physical and cognitive ability, their response to the situation may be clouded by fears and feelings of loss.

Be prepared to communicate with the transferring senior about these perceptions and complicating factors, particularly when a move is sudden and/or unwanted:

A loss of control – When change is thrust upon a senior (or anyone, for that matter), it is rarely welcomed, especially in the early going.  The sense that decisions are being made without their input and that they’re being forced to do something they don’t want to do may cause feelings of hostility and overt resistance.

Viewing the move as the end of an era – Leaving the family home and most of the possessions inside it is a very outward indicator that something significant is going on.  One’s status as a declining individual can no longer be denied.  While seniors are often aware of their own deficits, the transfer to a facility shines a bright light on the reality of it all, confirms that it’s not a passing stage, and indicates that their status as ‘fully independent’ is behind them.

Poor insight on self-care potential – Many seniors truly believe that they can return home and care for themselves, despite obvious signs to the contrary.  This compromised insight makes the move to a care community feel unjust and unwarranted.

Loss of confidence – The familiarity of home, no matter how isolating or imperfect the past many years there have been, builds a sense of orientation, control and comfort.  This is particularly true for those contending with erosions in their cognitive ability.  A new environment, on the other hand, presents challenges related to learning and understanding new routines, people and geography.

The move is part of a larger series of events – In many cases, some triggering event has occurred to inspire the move.  The senior may have had a series of medical setbacks, trips to the hospital, stays in rehab, and now a more permanent shift away from home.  Perhaps they recently lost a spouse.  The trauma related to the transfer is likely worsened when it comes as part of a much larger wave of disruption.

Stress Reduction

Some situations preclude preparation for a move – emergencies and the marked changes of direction they can produce may assure that there is no time to ponder or prepare for a very necessary move.  But if circumstances permit, the following tips may help prevent and/or soften the symptoms of Relocation Stress Syndrome:

Consider moving before it’s urgent – Although 88% of seniors report a desire to age in place at home, the benefits of staying home don’t always outweigh the downsides.  Some seniors become isolated, lonely and under stimulated at home.  Carrying out a move when there is no emergency and at an earlier age may make for an easier adjustment.

Involve the senior in the decision – Self-determination is vital to an adult’s sense of wellbeing.  Seniors should be kept in the loop and engaged in the decision-making process to the greatest extent possible.  The likelihood of acceptance and “buy in” to the new arrangement will increase dramatically if it’s known, chosen and properly “digested” before the actual move.

Validate their fears and feelings – Rather than cheerily glossing over negative feelings and concerns, acknowledge those feelings and offer support in working through the transition process.  Visit as often as possible or hire a care manager to be the senior’s ally.  A senior who feels heard may suffer less transition-related trauma.

Bring as much from home as possible – Furnishings from home add to a sense of familiarity.  When cognitive decline is a factor, take care to arrange shelves and dresser tops in just the way they were arranged at home to reduce confusion and novelty.

Personalize the experience – Facilities are making huge strides in allowing for the variable routines and habits of the residents they house.  Flexible meal schedules allow late sleepers to continue their late-sleeping ways without losing out on the possibility of breakfast. The better acquainted the facility is with the wishes, habits and routine of the new resident, the more effectively they can work to fit the environment to the person rather than the person to the environment.

Engineer social opportunities – Few things are as powerful in making a person feel at home in a new space as the development of friendships.  Steering new residents toward activities that speak to their existing interests may help them find people with whom they have things in common. Helping new residents find other new residents gives them the comfort of shared experience as they all navigate new surroundings.

Try not to respond to transfer trauma with another transfer – Stress related to moving probably won’t be quelled by moving yet again. Three to six months is a general timeframe in which to expect continued adjustment before determining that a facility may be a poor fit. Any signs of neglect, bullying, improper care and/or compromised safety are, of course, exceptions to this rule, and warrant immediate attention.

Adjustments take time.  The most successful adjustments may start before the actual move, during the consideration and planning period when important mental processes take place.  If a senior feels they are a part of the decision and they have time to absorb the change emotionally, the move may produce little or no trauma.

In non-urgent situations, it’s a good idea to visit the facility for meals and activities long before the move is underway.  Consider a respite stay as a “dress rehearsal”. Do what’s possible to make the unfamiliar feel more familiar, especially when memory loss is a factor.  Communicate with both the senior and the facility and be as available as possible to help manage indicators of stress.

© Lifecare Innovations