Main image courtesy of the Portland Press Herald.

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Everyone likes the feeling of being comfortable in their own home. We surround ourselves with items that make us happy, we make memories, and share our space with loved ones. However, due to the onset of a decline in cognitive abilities that come with conditions such as dementia, our older loved ones sometimes cannot safely stay in their home. Other times, seniors already in a facility need to be moved to a new area or a new living community because they need higher levels of care. This can be very disruptive to dementia patients.

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These are just two major circumstances that can lead to transfer trauma. But what is transfer trauma in dementia patients, and how can the staff of your nursing facility prevent and treat it? In this Mariposa guide, we’re going to cover the following topics:

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• What transfer trauma in dementia patients is and what causes it
• Who is at risk for transfer trauma
• What you can do to prevent transfer trauma in your facility
• Tips to minimize transfer trauma

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What is Transfer Trauma?

Transfer trauma in dementia patients

Transfer trauma in dementia patients is a very real condition that can affect the psychosocial well-being of seniors. Image courtesy of NBC News.

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We all like being able to wake up and go about our daily routines, and come back to the same safe space. It is familiar, comfortable, and makes us feel in control of our situation. However, this gets complicated when our older loved ones start to cognitively decline and can no longer stay in the space that they call home. It can be a tough decision to move your loved one to a safe, senior community where they can get the care and assistance that they deserve. It is even more difficult when your loved one does not want to leave, and cannot understand why they are being forced out of their safe space.

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Additionally, asking seniors already living in a community to change their room, bed, or building—and therefore their routine—can also be met with anger, fear, and sadness. In dementia patients, these negative emotions can be even more pronounced.

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Transfer trauma, also known as relocation stress syndrome, is defined by a series of reactions to a sudden change in environment. Change is hard for everyone, but it can be even more complicated with those who are cognitively impaired. They may not fully understand the situation, or even be aware that they are no longer able to care for themselves. Transfer trauma occurs because of a loss of control, and dementia patients feel that they no longer have any say in where they are going to live. This can produce a lot of anxiety and fear, which can lead to a decline in physical, mental, emotional, and social well-being. 

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In fact, the chance of a senior’s health declining, including instances of premature death, increases after a relocation or change in environment. Studies into this correlation eventually led to the official diagnosis of relocation stress syndrome in the early 1990s. 

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The symptoms of this condition can last anywhere from a few days to weeks, but it does not have to be an inevitable fact of moving locations. While it’s important to consider it can take up to 30 days for someone to become adjusted to a new environment, it’s essential to be watchful of some of the symptoms of transfer trauma including:

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• Sadness/depression
• Anger/combativeness
• Wandering
• Withdrawal from social activities or hobbies
• Weight loss or gain
• Irritability
• Confusion
• Refusing care
• Failure to thrive

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What are the Main Causes of Transfer Trauma?

Know what causes transfer trauma in order to avoid it

No one wants a senior with dementia to experience transfer trauma when they need to change environments. Image courtesy of Paradigm Senior Living. 

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Transfer trauma can occur anytime someone is introduced to a new environment. This can mean moving from a home into a senior care facility, changing rooms, or moving to a new facility for additional levels of care. All of these can cause significant disruptions in routines—as residents need to not only get accustomed to new surroundings—but also new staff members and unfamiliar roommates or neighbors.

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Transfer trauma is typically caused by:

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• Fear. Fear of the unknown can affect anyone, but especially if it is a senior moving into a new environment. Fear can also be a consequence when the senior feels they have not had a say in this decision, and it is not a voluntary move. This can trigger anxiety over how they will adjust. When the move is involuntary, many seniors with dementia may wonder why they are being moved, and continually ask to leave or to be taken home. 

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When staff and family members go in knowing this type of reaction is the result of fear, it can make it a little easier to find ways to help the new resident properly adjust.

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• Loss. Transfer trauma is also caused by loss, which can ignite feelings of fear in patients with decreasing cognitive abilities. Loss of their familiar surroundings (whether it’s their home or former room/facility) and the loss of the staff that took care of them can trigger the symptoms of transfer trauma.

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• Lack. Having a routine is very important to all of us, including those who are experiencing dementia. When they lack what they are accustomed to and have to move from one level of care to another, it can be a very abrupt change. Patients also become more susceptible to this syndrome when they feel they were not consulted prior to the decision to change environments, that their opinions were not considered, and they lacked the opportunity to give their input. 

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Knowing what the root causes of transfer trauma are can make it easier to put a plan in place to help alleviate some of these issues. Putting staff and family in the shoes of the patients can open their eyes to see how a change in surroundings can cause significant disruption, which can spill over into their physical, mental, and emotional states.

Who is at risk for transfer trauma?

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The individuals at the greatest risk for transfer trauma are senior individuals who are dealing with dementia and a decline in cognitive abilities. Their negative reaction and change in behavior to this type of adjustment is “appropriate” to these residents because it is based on fear and loss. When their familiar surroundings are taken from them, they tend to react out of fear since they can no longer cognitively understand their need for more assistance.

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Fear and anxiety can induce the signs and symptoms of transfer trauma until the resident has had an opportunity to adjust to their new environment and learn to familiarize themselves with it. When staff at the facility are prepared for residents in this way, it can help to make this transition easier. 

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Those individuals who are not making this move voluntarily are also at a greater risk for transfer trauma. Changing their surroundings and routine without their consent or input can make anyone feel diminished. Again, this goes back to fear and anxiety that can develop in residents with dementia who are fearful that they no longer have complete control over what happens to them. This can also cause anxiety since they are also not given the opportunity to determine what’s best for themselves. 

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What Can You Do to Prevent (and Treat) Transfer Trauma?

There are ways for staff and family members to help prevent and treat transfer trauma

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Including the resident in the decision to move locations can help reduce the chances of transfer trauma. Image courtesy of the Irish Times.

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Now that we’re more aware of transfer trauma and how it can have serious implications on the health and well-being of dementia patients, it’s important to know how both staff and families (and even the receiving nursing care facilities) can work together to help prevent it.   

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Two strategies that are considered helpful to preventing transfer trauma:

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• Include a social worker or other patient advocate. Social workers and other patient advocates can ensure the patient is getting the right level of care, and is placed in a facility that is able to meet their medical needs. Social workers can also determine whether a patient is being transferred too quickly or whether a change in the level of care is necessary.

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• Involve the patient as much as possible in the decision. Even in patients with cognitive decline, experts believe one of the best ways to prevent transfer trauma is to involve the patient to an appropriate degree in the decision. This helps to mitigate the fear and sense of loss that can cause transfer trauma in the first place. When the process is slowed down to include the input of the patient (such as taking the time to visit the facility ahead of time) it may be less likely they develop the behavioral symptoms of transfer trauma. 

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Additional ways to decrease the chance of transfer trauma

Staff

Since staff will be working with the resident on a daily basis, it’s crucial they are prepared with the right training. Ensure they’re aware of the signs and symptoms of relocation stress syndrome, and that they know their role in helping the new resident adjust to their environment. Whether it’s a transfer from home to a facility, or to a new room, this can be difficult for a resident with dementia. 

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Staff should know that they have a say in how this type of problem is resolved, and that their input and experience with these situations is welcomed. Staff can also act as a liaison with family, and can communicate to them any escalating concerns. 

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The care facility should encourage staff to pay attention to the new patient, and be observant of the resident’s mood and behavior. Continual assessments such as weight and eating behaviors should be tracked.

Families

There are a variety of different emotions that can come to the surface when a family needs to move an elderly loved one into a nursing facility. They can feel guilty, sad, confused, or have no idea how to go forward. It’s important that the staff and facility that is receiving their loved one be open and communicate with them to let them know it is normal for them to feel this way. It may also be helpful to have resources made available for families to use, such as a support group of other families in similar situations. 

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Tips to minimize transfer trauma

Although it is ideal for nursing facilities and families to prevent transfer trauma, there are additional things they can do to help minimize it. 

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• If possible visit the facility before the move. If the family is able to coordinate a time that works for their loved one to visit the new facility, openly encourage this. Allow time for them to get to know some of the staff or residents, and possibly even participate in some activities. When the time comes to move, it won’t seem so unfamiliar when they may remember a face or a room.

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• Have a good welcoming process. In order to make the transition a little smoother, go above and beyond to make the resident feel welcome and at home. Ensure staff knows their preferences, and maybe even a little something about their past or personal life beforehand. This can assist with the adjustment and make new residents feel more comfortable in their new space.

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• Encourage them to make friends and participate in activities. When staff are aware of residents’ hobbies or interests, this can make it a little easier to gain their trust.

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• Create a living space that feels like their old one by organizing it the way they want it, and include familiar items such as pictures, knick knacks, or their favorite pillow or blanket.

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• Keep family members involved and encourage more visits to help the resident settle in. Seeing their loved ones is important to help them feel secure, and it can easily be made a part of their new routine.

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• Ask them how they’re feeling and encourage them to express their emotions.

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Transfer trauma is a condition that can affect dementia patients at a very vulnerable time in their lives. Ensuring proper communication between staff, family, and nursing facilities can help create a smoother transition.

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