Geriatric Mental Health Disaster and Emergency Preparedness

Chapter 14 Geriatric Assessment for Differential Diagnosis 275
ily, social isolation, lack of independence as measured by scales of ADLs
and IADLs, chronic medical and mental illness, current medication use,
and prior use of health services determine the risk of pathology.
The physical and psychological distress of being uprooted from one’s
residence or institutional setting during a disaster has been labeled transfer
trauma, implying that any disruption from an individual’s normal surroundings
in the chaos of a disaster leads to worsening anxiety, depression,
and cognitive blunting. The amount of time needed for the transfer and the
individual’s needs on the other end have been underestimated, leading to
worsening anxiety and distress on the part of the older client (Mangum,
Kosberg, & McDonald, 1989). Nursing home staff who have handled transfers
of clients from their facilities have a wealth of experience and information
and should continue to share this knowledge with program directors.
For example, nametags on all residents, many of whom have dementia and
cannot give their name and are thus more likely to become confused, are
valuable in reducing further psychological distress in these clients (Aldrich
& Benson, 2008).
The process of packing one’s possessions quickly in the midst of an impending
disaster and being herded onto buses or planes and ending up a
day or so later in a new city, a temporary shelter, the unfamiliar home of a
stranger, or even the comfort of a family member’s home is disquieting, upends
equilibrium, and can worsen mental confusion or underlying cognitive
impairment or emotional instability. Follow-up studies of older persons relocated
from their homes after disasters show that 6 months to several years
later there was a higher rate of depression, anxiety, and dread (Burns, et al.,
1993).
Older persons, who are prone to multiple sensory impairments, are vulnerable
because they do not receive early warnings about disasters, are less
likely to respond to information regarding an impending disaster, and have
less capacity to plan ahead (Friedsam, 1960). However, older persons may
be less impacted by disaster and seem to have a resourcefulness and coping
ability greater than the younger population. Older adults often have timelimited
psychological distress after a disaster that resolves over a period of
several months without treatment (Burns, et al., 1993). This may reflect
prior learned coping strategies and life experiences, which may aid them in
the management of disaster conflicts (Raphael, 2003). Older persons may
have fewer current-life stressors and less need for additional conflict resolution
subsequent to a disaster. There may be a learned effect from prior
trauma for coping and problem solving (Verger, et al., 2004). Frail older
persons—those with serious physical, cognitive, economic, and psychosocial