Toward Integration of Trauma, Resilience, and Equity Theory and Practice: A Narrative Review and Call for Consilience.

Investigating the roots of health and illness has inspired unprecedented growth in research on trauma and adversity across academic and scientific disciplines. Can this science achieve its potential? How? Much of this research remains siloed and fragmented, limiting integrative approaches to translating science into a unified paradigm. From age-old traditions to the health, social, and basic sciences, this established and rapidly growing body of work has overwhelmingly found that experiences, both positive and negative, profoundly influence life course health. Such convergence across disciplines highlights the complex, intersectional nature and impact of experiences and reveals consilience: agreement of findings across diverse fields. This narrative review explored 400 sources to curate a representative sample of 98 tracing the evolution of trauma theory and practice from the 19th century to the present. It emphasizes research from 1970 to 2022, with a specific focus on adverse childhood experiences, everyday discrimination, sexual and gender minority stress, acculturative stress, and positive childhood experiences. This research reveals how experiences are a cause, catalyst, and key ingredient of health or of illness, disability, and disparities. The review also proposes steps toward a unified paradigm and showcases innovative integrated models and applications. These examples provide a more comprehensive and nuanced understanding and lead to more effective solutions. Recognition of consilience can connect multidimensional insights on trauma, resilience, and equity to spark further cross-sector innovations toward health, prevention, and justice. Realizing the promise of consilience will require a new era of radical intentionality, ongoing dialogue, and interdisciplinary collaboration to achieve necessary system transformation.

Roadmap for Trauma-Informed Medical Education: Introducing an Essential Competency Set.

Research has established that trauma is nearly universal and a root cause of numerous health and social problems, including 6 of the 10 leading causes of death, with devastating consequences across the life course. Scientific evidence now recognizes the complex injurious nature of structural and historical trauma (i.e., racism, discrimination, sexism, poverty, and community violence). Meanwhile, many physicians and trainees grapple with their own trauma histories and face direct and secondary traumatization on the job. These findings substantiate the profound impact of trauma on the brain and body and why trauma training is critical to the education and practice of physicians. However, a critical lag remains in translating essential research insights into clinical teaching and care. Recognizing this gap, the National Collaborative on Trauma-Informed Health Care Education and Research (TIHCER) formed a task force charged with developing and validating a summary of core trauma-related knowledge and skills for physicians. In 2022, TIHCER released the first-ever validated set of trauma-informed care competencies for undergraduate medical education. The task force focused on undergraduate medical education so that all physicians would be taught these foundational concepts and skills from the outset of training, recognizing that faculty development is needed to achieve this goal. In this Scholarly Perspective, the authors offer a roadmap for implementation of trauma-informed care competencies starting with medical school leadership, a faculty-student advisory committee, and sample resources. Medical schools can use the trauma-informed care competencies as a scaffold to customize integration of curricular content (what is taught) and efforts to transform the learning and clinical environments (how it is taught). Using the lens of trauma will ground undergraduate medical training in the latest science about the pathophysiology of disease and provide a framework to address many of our greatest challenges, including health disparities and professional burnout.

Relating wrist accelerometry measures to disability in older adults.

OBJECTIVE: This analysis assessed the extent to which: (1) wrist accelerometer measures were associated with difficulty performing specific activities of daily living and instrumental activities of daily living and (2) these measures contributed important information about disability beyond a typical self-reported vigorous activity frequency question. METHODS: We used data from the National Social Life, Health and Aging Project (NSHAP) accelerometry sub-study (n=738). Activity was assessed using two wrist-accelerometer measures assessed over 3 days (routine activity expressed as mean count/15s epoch during wake time, and immobile time expressed as the proportion of wake time spent immobile), and self-reported average vigorous activity frequency. The association between routine activity, immobile time and difficulty performing fourteen activities of daily living (ADLs) and instrumental activities of daily living (IADLs) plus two summary measures (any ADL or IADL difficulty), was assessed using logistic regression models, with and without controlling for self-reported vigorous activity. RESULTS: Self-reported activity was mildly correlated with routine activity (r=0.27) and immobile time (r=-0.21). Routine activity, immobile time, and self-reported vigorous activity were significantly associated with twelve, ten, and fourteen disability measures, respectively. After controlling for self-reported activity, significant associations remained between routine activity and eight disabilities, and immobile time and six disabilities. CONCLUSION: Wrist accelerometry measures were associated with many ADL and IADL disabilities among older adults. Wrist acclerometry in older adults may be useful to help assess disability risks and set individualized physical activity targets.

Geriatric syndromes and functional status in NSHAP: rationale, measurement, and preliminary findings.

INTRODUCTION: The geriatric functional measures and syndromes collected 5 years apart in Waves 1 and 2 of the National Social Life, Health, and Aging Project (NSHAP) data set included: difficulty with activities of daily living and instrumental activities of daily living, the timed up and go, a 3-m timed walk, repeated chair stands, self-reported physical activity, accelerometry-assessed (in)activity, falls, fractures, and frailty. The purpose of this paper was to describe the data collection methods and report preliminary population estimates for each measures. METHOD: Frequencies, means, or medians were estimated for each measure stratified by age and gender, using the age-eligible samples in Wave 1 (n = 3,005) and Wave 2 (n = 3,196). An adapted phenotypic frailty scale was constructed in the sample common to both waves (n = 2,261). Changes over 5 years were reported for four measures common to both waves. RESULTS: The functional measures worsened with age (p < .001). The syndromes were more prevalent with age except "all fractures" (p value range < .001-.03). Functional measures were worse among females than males except chair stand performance and the accelerometry-assessed (in)activity measures (p value range < .001-.01). The syndromes were more common among females than males except Wave 2 falls and Wave 2 hip fractures (p value range < .001-.03). Changes from Wave 1 to 2 revealed 11.5%-25.2% of individuals reported better health and 21.3%-44.7% reported worse health. DISCUSSION: The NSHAP provides a comprehensive assessment of geriatric health. Our findings are consistent with the literature and support the construct of the study measures.