Geriatric Mental Health Disaster and Emergency Preparedness

276 Geriatric Mental Health Disaster and Emergency Preparedness
problems—are at especially high risk (Fernandez, et al., 2002). The risk factors
for developing psychological distress after a disaster relate to the ability
of the affected individual or community to assess and respond to the
warnings of a disaster; to prepare ahead and organize one’s life to prepare
for escape routes; to hunker down, establishing and maintaining contact
with social supports; and to possess the resources and forethought to have
on hand adequate supplies of medication.
During the Gulf Coast hurricanes of 2005, frail older persons in nursing
homes, unable to independently manage and negotiate a chaotic system,
were the most affected. The highest incidence of death of any segment of
the cohort was from nursing home elderly residents who were unable to be
relocated during the crisis (Summers, Hyer, Boyd, & Boudewyns, 1996). Before
hurricanes Katrina and Rita in 2005, adults aged 60 or older made up
only 15% of the population of New Orleans, Louisiana. However, 71% of
those who died because of the hurricanes were over age 65 (White House,
2006). For all segments of the population, it is clear that the closer one is
to the heart or ground zero of a disaster, the higher the risk for the subsequent
development of PTSD, anxiety, substance and tobacco use, alcohol
abuse, depression, and impaired functioning in the daily activities of life.
Older persons who lived below Canal Street in New York City, which
was designated a frozen zone for weeks after the terrorist attacks of September
11, 2001, are a case in point. These frail homebound older persons
could not receive any communication from outside support for days on end.
This was the group most likely to decompensate in their mental and physical
health. Members of this group are often unable to ambulate due to
the typical chronic medical illnesses affecting this population, including
chronic respiratory illness, debilitating arthritis, cardiovascular disease, and
stroke. The home attendants who served this group were unable to reach
their clients. It is noted that more intensive efforts were organized to retrieve
at-risk homebound pets than older persons.
The greater the impact of a disaster directly on one’s life, the greater the
risk for the onset of psychological distress, so in the assessment we must understand
where the person was at the time of the disaster: were they moved
or forced to remain in place? Did they have any support or companionship
at the time of the disaster, and was the support consistent or fleeting?
Frail older residents who choose to remain in their homes during a hurricane
are not unusual and, in fact, are the norm for the older population.
Whether we use the term set in their ways or too old to change, it is clear
that older persons are less likely to respond to requests to vacate their premises
and move to safer areas. This is likely also related to the length of time