Geriatric Mental Health Disaster and Emergency Preparedness

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