Geriatric Mental Health Disaster and Emergency Preparedness

Chapter 10 Psychosocial and Pharmacological Interventions 177
wise wrongly be viewed as clinical symptoms is paramount to a person’s
wellness postdisaster.
It is imperative that the disaster mental health clinician is aware of
the individual’s baseline functioning prior to the traumatic event in order
to understand the interaction of pre-event, event, and post-event contributions
to an individual’s response to disaster. The latter interaction
may not only provide the clinician with a tool for comprehensive assessment
but also may lead to very specific intervention strategies that incorporate
pre-event functioning. Table 10.1 provides a guide for assessing
eight specific modalities a clinician should investigate. Examples provided
within each domain are not meant to be all-inclusive but can prompt
the clinician’s queries and reveal more relevant information. Ultimately,
these areas should not be viewed as isolated categories but as domains
of experience that continually interact. It should also be noted that older
disaster victims may not be able to provide much of this information. In
such instances, the clinician should determine the availability of a key informant
to provide as much information as possible. Family members,
community-based and facility staff, peers, clergy, and others may be useful
during the assessment process.
All these domains greatly affect an individual’s ultimate response to a
disaster as well as how he or she may respond to varying intervention strategies.
Even without the devastation of a disaster, effective treatment
should consider these clinical areas—the experience of a disaster only
makes the need to do so more acute. The potential interactions between
disaster and these baseline modalities of experience are noteworthy. How
does disaster differentially affect the individual with a very structured,
compulsive daily routine? How might disaster influence a dependent
personality-disordered individual’s already intense interpersonal affect?
Is a disaster-caused injury aggravating existing chronic pain? Mix in a preexisting
cognitive impairment made worse by disaster and you have a compulsive,
affectively intense and labile, medically compromised person in
physical pain who is confused, disoriented, and without familial and social
support due to a long history of interpersonal instability and conflict.
While this hypothetical patient may be dizzying clinically, it likely underestimates
the complexity of most people, where the individual nuance of
a person’s past, present, and disaster experience create truly unique presentations.
This complexity is intensified in older persons. In addition,
while this example highlights clinical problem areas and their interaction,
strengths can be assessed in each modality and their interactions observed
and utilized to foster positive coping responses to disaster. Might