Geriatric Mental Health Disaster and Emergency Preparedness

274 Geriatric Mental Health Disaster and Emergency Preparedness
inaccessibility of services, a fear of being labeled as mental patients, and a
cohort effect where mental health treatment is seen as outside the realm
of acceptable services to access (Brown & Harris, 1989). Of particular concern
are frail older adults who are less likely to have their broad needs met
after a disaster (Sanders, Bowie, & Bowie, 2003). Older persons tend to utilize
available services less frequently than the general population (Zatzick,
2007). They may not take advantage of counseling or support services, they
may be embarrassed to accept handouts, or they may feel others are more
deserving of assistance than they are (Oriol, 1999). Case finding becomes a
critical issue and calls for creative solutions including the delivery of mental
health services in multidisciplinary teams, which have the ability to outreach
into the community where stigma can be reduced. Mental health services
at a primary care medical clinic or senior citizens’ center may be practical
solutions to this problem by minimizing the stigma of evaluation at a mental
health facility.
RISK FACTORS AND PSYCHOLOGICAL
IMPACT OF DISASTERS
The chronological age of the individual is not the critical issue in the development
of psychological distress subsequent to a disaster. Relative independence,
pre-disaster health and mental health status, social support,
economic status, employment status, marital status, and access to services
predict mental health stability after a disaster (Brown, 2007). The frail elderly,
seniors who function with a limited margin for additional physical and
psychological burden and are dependent on a support system for their dayto-day
care; the institutionalized elderly in nursing homes; and clients with
pre-disaster PTSD or psychopathology are at highest risk for psychological
distress after a current disaster (Capezuti, Boltz, Renz, Hoffman, & Norman,
2006). The psychological impact of disasters on older persons has been a
matter of debate. Frail older adults with chronic medical and mental disorders
are more likely than the healthier or younger population to require
assistance to evacuate, survive, and recover from a disaster (Fernandez,
Byard, Lin, Bensen, & Barbera, 2002). The type of disaster, its severity and
longevity, the efficiency of the advanced warning system, the pre-disaster
health and mental health status of the individual, and access to resources
and economic constraints are variables implicated in the psychological vulnerability
of older persons (Bolin & Klenow, 1982). The proximity to the
disaster, the length of exposure, the threat of loss of life to oneself or fam-