Geriatric Mental Health Disaster and Emergency Preparedness

182 Geriatric Mental Health Disaster and Emergency Preparedness
review in the following intervention section, set the context for how to best
help older persons in a disaster.
INDIVIDUALIZED, DYNAMIC, AND RESILIENCY-BASED
INTERVENTION APPROACHES
What clinical intervention and support should be provided during and
following a disaster is, perhaps, the greatest ongoing controversy in the
disaster mental health intervention literature. Questions that remain to
be answered conclusively include the following: What intervention strategies
are most effective and at what time? Are there potential deleterious
implications of particular interventions? How much structure, following
protocol, versus individualization should interventions possess?
Just as symptoms need to be evaluated in time context relative to a
disaster, treatment interventions must also be temporally sensitive. Interventions
during the midst or within the immediate unfolding of a disaster
would obviously differ greatly from interventions for an individual still
suffering from sequelae 6 months postdisaster. Accordingly, this section
not only integrates the previous sections of clinical assessment strategies
and factors promoting resilience, but it identifies how interventions
would typically be employed over time to older victims of disaster. The
remainder of this chapter will review and summarize both psychosocial
and pharmacological intervention strategies in the during, immediate, and
longer term follow-up stages of recovery from disaster.
EVIDENCED-INFORMED, DURING-DISASTER
INTERVENTIONS
During-disaster interventions are driven by a basic pragmatism that guides
helpers to first promote and protect safety, increase comfort, decrease pain
and discomfort—both physical and psychological — and provide an environment
that promotes inner security. In a publication dedicated to providing
clinical guidance to disaster mental health clinicians that incorporates
evidenced-informed practices, which is necessary due to the dearth of internally
valid studies that would illuminate evidence-based practice, Hobfoll
and colleagues (2007) outlined the hierarchical progression of how
intervention strategies should unfold in response to disaster. In addition,
these target areas are also consistent with the consensus reached in the