Geriatric Mental Health Disaster and Emergency Preparedness

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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
Table 10.2 DURING-DISASTER SYMPTOM DOMAINS AND COMPREHENSIVE ASSESSMENT BEHAVIORAL AFFECTIVE SENSORY IMAGERY COGNITIVE INTERPERSONAL PHYSIOLOGICAL SPIRITUAL “Primitive” questioning of religious beliefs/ Question of “ why ” *** Sense that “everything has been lost” *** Pervasive “pointlessness” Disaster-caused injury *** Trauma/stress induced medical complications *** Aggravation of existing medical issues *** No access to medical/psychiatric medications *** Aggravation of the above with agingrelated health varables *** Increased hypertension and related complications Loss of social and familial support due to death/injury *** Social and familial self-images radically altered *** Relocation induced social withdrawal and isolation Impaired cognitive status and disorientation *** Confusion, aggravated by lack of clear, valid information *** Inability to focus; and easily distracted *** Aggravation of pre-existing memory problems *** Altered basic attitudes toward world, self, others, and perceived lack of security and safety Frightening, intrusive, and repetitive imagery of disaster *** Images of selfinadequacy to cope or help others *** Images of death (self and others) Sensory/ perceptual overload/ Aggravated impairment of capacities across hearing, vision, and other senses *** Pain associated with disasterinduced injury, or disasteraggravated medical conditions *** Sensory disorientation (delirum) Intense, erratic emotional lability; feeling overwhelmed *** Emotional numbing *** Painful loss of people and possessions *** Rage, terror, fear, guilt, *** Aggravation of pre-existing mood problems Skills/capacity for selfregulation, not attending to basic self-care *** Agitation or decreased overall activity level *** Withdrawal and isolation *** Routine disruption/Lack of governing structure life
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Geriatric Mental Health Disaster an
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Geriatric Mental Health Disaster an
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Dedicated to Flo Aaroe, who personi
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Contributors xi Foreword by Robert
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14 Geriatric Assessment for Differe
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xii Contributors Terry Fulmer, PhD,
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xiv Contributors Douglas M. Sanders
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Foreword With the increase in the n
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Preface The rage you feel does more
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Preface xxi and (3) influence the d
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Preface xxiii as key to the prepara
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Acknowledgments In connection with
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1 A Primer for Disaster and Emergen
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Chapter 1 A Primer for Disaster and
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2 Older Persons in Disasters and Em
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Chapter 2 Older Persons in Disaster
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NORMAL CHANGES WITH AGING ORGANS/SY
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Immune Function Laboratory Tests Em
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48 Geriatric Mental Health Disaster
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Table 3.3 GEC GEPR COLLABORATIVE PR
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Table 3.3 GEC GEPR COLLABORATIVE PR
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Community Response to the Needs of
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5 National and Cross-National Model
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Chapter 5 National and Cross-Nation
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6 Supervision and Facilitated Refl
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INTERNATIONAL TREATIES Team Respons
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120 Geriatric Mental Health Disaste
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Chapter 12 Complementary and Altern
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Self-Care Chapter 12 Complementary
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13 The Interdisciplinary Treatment
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Chapter 13 The Interdisciplinary Tr
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Choose solutions Review literature
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14 This chapter focuses on the ment
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15 Bereavement and Grief: What Is N
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Chapter 15 Bereavement and Grief 29
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The Length of Mourning Chapter 15 B
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16 The Experience of Vulnerability
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17 Alzheimer’s Disease and Relate
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n Do your best to remain calm. The
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380 Appendix I A Guide to Developin
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390 Appendix II Glossary of Terms C
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A AAGP. See American Association fo
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community initiatives/lessons learn
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depression v., 287 during disasters
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Emergency preparedness, gaps in tra
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adverse reactions to, 226 conclusio
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health care provider training on, 7
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physical changes/resultant weakness
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supervisor component of, 110 -113,
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Spirituality of African Americans/A
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