Geriatric Mental Health Disaster and Emergency Preparedness

176 Geriatric Mental Health Disaster and Emergency Preparedness
approaches and how these treatments may be combined for optimally
effective intervention.
COMPREHENSIVE, INDIVIDUALIZED ASSESSMENT
As discussed in previous chapters, the growing research literature on responses
to disaster has not only delineated the normal reactions of individuals,
including older adults, but also has underlined the dynamic quality
of symptom presentation over time. While there is often considerable
overlap of pre-, during, and postdisaster responses, clinicians need to refrain
from static assessment processes that deem a person to be handling
it well in an early stage and assume this managed response will continue.
Krause (2004), in fact, indicated it may take years for disaster-related clinical
symptoms to dissipate and suggests that researchers and clinicians take
an extended longitudinal view of a person’s response to disaster. In addition,
previous exposure to traumatic events and premorbid psychiatric/
cognitive/medical status symptoms may buffer or exacerbate the presentation
of these symptoms.
The complexity of this assessment process requires a strategy that
considers all aspects of a person’s functioning and continually reassesses
these modalities over time. While Lazarus (1981) emphasizes the use
of seven such modes of functioning, this chapter will include spirituality,
or the existential domain, as the eighth sphere as the literature
points to the prominence of this area in understanding an older person’s
response to disaster. Similarly, attention must be given to the central
role of choice and choosing (Gurland & Gurland, 2008a, 2008b) in
maintaining an older person’s quality of life during disasters, including
Banerjee’s additional subdomains within choice and choosing: empowerment,
respect, and identity (Banerjee, et al., 2009). Overall, the effective
clinician will evaluate an individual across all spheres of their experience,
including the behavioral, affective, cognitive, sensory, imagery, interpersonal,
physiological, and spiritual-existential domains. While the
following tables comprehensively delineate symptoms as they may be
experienced across the time continuum of disaster, the interaction of
these symptoms needs to be assessed; this holistic orientation best captures
a person’s experience and will lead to more obvious and specifically
indicated treatments. Additionally, it is imperative that clinicians
realize that assumed resiliency and recovery from many of these symptoms
is the expected baseline. The normalization of what might other-