Geriatric Mental Health Disaster and Emergency Preparedness

Chapter 10 Psychosocial and Pharmacological Interventions 181
the disaster. In this example, the root or proximal cause of withdrawal is
highly specific to imagery. The best management of this symptom interaction
may be to target the provocative imagery with high clinical priority
and offer competing imagery to the suffering person (Lazarus).
RESILIENCY AND DISASTER MENTAL HEALTH
Assessment should also include a basic review of those factors that might
buffer the aforementioned effects of disaster. Many resiliency factors have
been identified in the literature. While the previous section focused on
symptoms often present in the wake of disaster, more recently much research
has focused on factors that mediate the expression of these symptoms
and that best predict resilience in the older population postdisaster.
The major factors that can potentially promote resilience, and that the clinician
needs to promote, include the following:
n Degree of disaster-event exposure, both static and ongoing
n Perceived family support
n Perceived community-based support
n Socioeconomic status/education level
n Culture
n Male gender
n Perceived nondiscrimination
n Evidence of pre-disaster psychiatric history
n Symbolic meaning applied to the disaster event
(Acierno, Ruggiero, Kilpatrick, Resnick, & Galea, 2006; Bolin & Klenow,
1988; Krause, 1987; Lawson & Thomas, 2007; Melick & Logue, 1985; Norris,
et al., 2002; Norris, Friedman, & Watson, 2002; Seplaki, Goldman, Weinstein,
& Lin, 2006; Ticehurst, Webster, Carr, and Lewin, 1996; Watanabe,
Okumura, Chiu, & Wakai, 2004; Weems, et al., 2007).
Interventions flowing from the assessment of resilience factors include
the following: limiting exposure to disaster, increasing actual or perceived
levels of familial and community-based support, ensuring equal
distribution of services to recipients without discrimination, and helping
an individual attempt to frame their experience in adaptive ways.
Formal intervention models have been developed and utilized effectively
using resiliency as a framework, such as Green and Graham’s (2006)
Resiliency-Enhancing Model (REM). Clearly, these factors, as we will