Geriatric Mental Health Disaster and Emergency Preparedness

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Chapter 10 Psychosocial and Pharmacological Interventions 185 and Mass Violence Review,” is a set of strategies focused on reducing the immediate impact of disaster-related stress (NIMH, p. 24). Hobfoll and colleagues’ (2007) hierarchical focus for effective intervention also applies to the next phase of disaster response. POSTDISASTER SYMPTOM DOMAINS AND COMPREHENSIVE ASSESSMENT Table 10.3 lists symptoms commonly experienced by older individuals in response to disaster after the immediate threat posed by the disaster has waned. While many symptoms may persist from a person’s during-disaster response, new symptoms typical of this stage may also appear. While there is considerable overlap in these symptoms, this provides the first opportunity for clinicians to begin to assess those individuals who may need a greater level of clinical care than that provided by baseline disaster outreach interventions. The clinician should look for the first signs of possible acute stress disorder (ASD) and possible PTSD-related symptoms, which would emerge and be diagnosed at least 6 months post-event. While PFA-type interventions may still be helpful for many of the listed symptoms, more formal intervention—such as more traditional psychotherapy and pharmacological interventions—may be indicated. LONGER TERM POSTDISASTER SYMPTOMS AND THEIR ASSESSMENT Table 10.4 lists symptoms experienced by individuals who have ongoing deleterious responses to disaster long after a disaster and its immediate effects have subsided. While it is rare for people to experience this persistence of symptoms from their during- and immediate postdisaster response, lingering chronic symptoms may arise, particularly if untreated at an early stage. The focus of assessment here is ASD and PTSD symptoms and their treatment. Table 10.4 assembles the symptoms of ASD and PTSD into an analogous multimodal chart form. Viewing these symptom areas as interactive, as opposed to isolated events, leads to more precise and effective treatment indications. While the following interventions are broken down into basic psychotherapeutic categories, the effects of interventions, like symptoms, are interactive. For example, a synergistic result of behavioral interventions affecting a
Table 10.3 POSTDISASTER SYMPTOM DOMAINS AND COMPREHENSIVE ASSESSMENT BEHAVIORAL AFFECTIVE SENSORY IMAGERY COGNITIVE INTERPERSONAL PHYSIOLOGICAL SPIRITUAL “Deeper” questioning of religious beliefs *** Question of why leading to anger and disappointment *** More grounded appraisal of the magnitude of loss *** “Pointlessness” of the event Disaster-caused injury *** Trauma/stress induced medical complications *** Exacerbated medical issues evolving to chronic status *** Limited access to or desire for engagement in medical/psychiatric medications *** Cued hyperarousal and associated cardiovascular problems *** Aggravation of the above with agingrelated health variables 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; 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 based on“reexposure” to disasterassociated stimuli *** Imagery cued by visual, affective, or other environmental triggers *** 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) Less intense but still erratic emotions *** Cued mood lability *** Breakthrough emotions vascillating with periodic numbing *** Cued, 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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Chapter 6 Supervision and Facilitat
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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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Chapter 14 Geriatric Assessment for
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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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Chapter 16 The Experience of Vulner
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17 Alzheimer’s Disease and Relate
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Chapter 17 Alzheimer’s Disease an
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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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Geriatric Mental Health Disaster and Emergency Preparedness

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