Geriatric Mental Health Disaster and Emergency Preparedness

Chapter 10 Psychosocial and Pharmacological Interventions 179
a dependent personality be more open to supportive help offered by a
clinician than someone with greater autonomy?
Following in Table 10.2 is a list of symptoms commonly experienced
by individuals as immediate responses to disaster. Symptoms that are
particularly common or noteworthy in older populations are well represented.
As you review Table 10.2, consider what interventions would be
appropriate for each specific symptom as well as for symptom clusters.
What interventions would be inappropriate or too far ahead of where a
client is? It is important to recognize if a disoriented client is currently capable
of answering the existential why questions of disaster: Why did this
disaster happen? Why so much pain and loss? What does the confused,
misinformed individual need? Does an individual consumed by pain attend
to, or are they even oriented toward, basic hygiene and self-care?
Does a person who just lost a loved one need detached reassurance that
everything will be okay or quiet support that respects their loss?
As you read these questions, grounded, realistic, and helpful thoughts
will come to mind as to how you might help individuals in these circumstances.
This, indeed, is a primary governing principle of much of disaster
mental health care—to provide very basic help to an individual given
their most acute needs at a specific moment in time. Basic reorientation
to time, place, and person, accurate information provision; quick referral
(escorting) to medical help; connection with supportive emotional loved
ones or pets; and nonverbally engaging (being with) a grieving person
are considered to be potentially on-target mental health interventions for
the aforementioned dispositions. Ultimately, the comprehensive and efficient
intervention approaches are often best informed by practical assessment.
For every symptom indicated in Table 10.2, there are direct and indirect
interventions the creative and flexible clinician can formulate. Intervention
strategies, however, become more complicated when considering
the potential multifaceted and interactive nature of issues across each of
these modalities. Obviously indicated calming or distraction-based techniques,
for example, are not likely to be effective with an older person
who views these particular activities and everything in general as pointless.
The interaction of these domains, in what Lazarus (1981) describes
as the establishment of a firing order, should also be undertaken. Consider
the following example of treating social withdrawal. A person’s desire for
isolation may be caused by intense fear and terror, which, on close examination,
may be sporadically elicited by repetitive and intrusive imagery of