Geriatric Mental Health Disaster and Emergency Preparedness

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Chapter 10 Psychosocial and Pharmacological Interventions 189 Imagery-Based Interventions Imagery-based interventions can be helpful in not only reducing current distress, but they may also be used to facilitate the acquisition of coping skills. An example of the former would be focusing on imagery that promotes relaxation and serves as a means of promoting calm and a sense of safety. This can also supplant disaster-related, repetitive, and intrusive imagery. Future-based imagery can also help restore the temporal sense often lost in disaster and help individuals restore hope. Coping imagery encourages patients to see themselves as strong and resilient and may, more specifically, encourage them to imagine using coping techniques as taught by a disaster mental health clinician. Psychodynamic and Existential Models While this model category is extremely broad and should be utilized only if the client directs or leads the intervention toward these clinical issues, it is an area identified as being paramount to many individuals’ recovery. This area of intervention, it should be noted, is more specifically likely to be a focus for older persons as existential issues become more acute in later years, and age-related existential anxiety may strongly interact with the experience of disaster. This model, overall, can help place the disaster within a personalized, narrative frame; help individuals attempt to make some meaning or sense of the event; or help an individual begin to incorporate this experience into their larger sense of having a purposeful and meaningful life. It should be noted that some of the aforementioned intervention paths may actually increase distress, and they should only be used when the person is ready to process the material. These clinical areas, however, remain influential in most people’s prognosis and should, at the very least, be incorporated into the assessment/treatment process. PSYCHOPHARMACOLOGY AND TREATMENT OF PTSD AND PSYCHOPATHOLOGIC SYNDROMES IN THE GERIATRIC POPULATION The use of psychotropic medications in older victims of disasters and those who have current symptoms and signs of ASD or PTSD requires careful administration and titration of doses for all categories, including antidepressant medications, anxiolytics, hypnotics, and, when required, antipsychotics. The general approach to medication in older persons is to
190 Geriatric Mental Health Disaster and Emergency Preparedness start at the lowest dose possible and increase slowly based on the individual’s clinical response and side effects. Normal aging is associated with the slowed metabolism of all medications in the kidney and liver, and, since most psychotropic medications are metabolized this way, dosage adjustment needs to be considered (Flint, 2004). A general principle is to choose the psychotropic agent with the shortest half-life to avoid the accumulation of the medication and its active metabolites in the client. For example, when choosing a benzodiazepine for an older person, we would use lorazepam, which is not metabolized by the liver, rather than the long-acting diazepam, which, with its active metabolites, accumulates for several days. As discussed in this chapter, the use of all psychotropic medications should be considered only in those clients whose symptoms so overwhelm their functionality that psychotherapy alone cannot be implemented or would best be augmented by medication. Psychotropic medications should not be used in the acute stage of a disaster when emotional supports and psychological comfort often suffice. Situational anxiety and depression of a mild to moderate degree of symptom severity will respond over a brief time to the nonmedication strategies discussed in this chapter. Therefore, the question arises as to when one should consider referral to a psychiatrist for a trial of medication. Again, we should examine the degree and intensity of symptoms, the impairment of vegetative functioning, and the overall level of distress in our client. A risk-benefit analysis must determine if a medication trial outweighs the risks of potential side effects. All psychotropic medications will increase the risk of falls, gait disturbance, sedation, mental confusion, sensory impairment, and physical symptoms such as lowering the blood pressure (hypotension), disturbing dryness of the mouth, and constipation. The older client is often reluctant to take any medication for psychological distress and might feel it would be a character weakness to do so. The literature on research for the treatment of PTSD in the older person with pharmacologic agents is sparse as limited studies specifically test agents in older persons’ population (Mohamed & Rosenheck, 2008). On the other hand, if the client has signs of severe depression with suicidal intent, delusional thinking, and overwhelming anxiety, including dread and panic that disable their activities, then medication would appear to be indicated. If a medication trial is initiated, the clinician should titrate the dose to an effective level and monitor the client on a regular weekly basis until symptom relief has been attained. In an acute disaster, we might consider
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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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Page 196 and 197: VOLUNTEERS PROVIDING AND RECEIVING
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Self-Care Chapter 12 Complementary
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Chapter 12 Complementary and Altern
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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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