Geriatric Mental Health Disaster and Emergency Preparedness

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Chapter 14 Geriatric Assessment for Differential Diagnosis 277 they have lived in their current residence, their attachment to their surroundings, and the age cohorts that comprise the residents in their home (Gibson & Hayunga, 2006). If they live alone or with a spouse, it may be easier to remain in place than respond to an evacuation call. A strong risk factor for psychological distress from a current disaster is having had psychological distress from a prior disaster event. Fifty to 75% of older persons in the community have experienced at least one disaster in their lifetime, and this data holds up for the population in general. If we examine those clients who have experienced disasters in the past, we can ask if the new disaster experience will uncover biological or psychological vulnerability. Prior disaster experience has been hypothesized to cause an inoculation effect—protection afforded for having experienced a prior trauma (Eysenck, 1986). OLDER POPULATIONS STUDIED Significant interest in the research on trauma psychology in older persons has focused on combat veterans, prisoners of war, survivors of the Nazi Holocaust, and aging Vietnam veterans (Beckham, et al., 1998; Danieli, 1981; Yehuda, et al., 1996), and more recently older hurricane survivors in the Gulf Coast. Findings of psychological distress in acute and longitudinal studies vary. Older Holocaust survivors have been shown to have considerable strength and coping skills. In contrast, Israeli Holocaust survivors during the Persian Gulf were found to have a significant incidence of PTSD symptoms and acute distress (Solomon, Neria, Olny, Waysman, & Ginzburg, 1994). The assessment of the older client must include an understanding of cultural issues particular to the client that may impact on the extent and severity of symptoms, the expression of distress, and reasonable treatment options. For example, older clients with Asian backgrounds tend to be unable to express their emotions outright and will often somaticize their distress. Anxiety and depression may present with weakness, lethargy, and fatigue. The Impact of Loss on Psychopathology The assessment of psychological distress in the older client must include a complete review of the impact of the disaster on their lives: the loss of cherished persons, belongings, and function. The death of a spouse, child,
278 Geriatric Mental Health Disaster and Emergency Preparedness friend, caregiver, or other close person is a certain risk factor for ensuing emotional instability, bereavement, and grief; it also creates a gaping hole in one’s sense of support. An individual’s sense of security is demolished in the context of a disaster; the basic fear that one is unprotected will resurrect primitive fears of childhood insecurity, abandonment, and separation anxiety (Zatzick, 2007). The loss of possessions, familiar households, cherished mementos of the past, and familiar space are key determinants in worsening cognition and a sense of disorientation, dread, and insecurity. The transplanted nursing home residents in New Orleans gave up the basic remnants of their surrounding when they were relocated. They were likely predisposed to confusion and anxiety. Over 50% of nursing home residents have a dementing disorder that adversely affects their ability to manage safely and negotiate their existence outside an institution. Strategies learned from previous disasters include developing crisis intervention teams that can assess older persons in the community and provide basic services such as housing, financial assistance, and securing a sense of safety (Phifer, 1990). Exposure to some types of traumatic events may also be higher in rural areas. For example, injury-related death rates are 40% higher in rural populations than in urban populations. Many rural older adults experience low levels of social support and high levels of isolation. Rural areas often have fewer resources—such as transportation, community centers, and meal programs—that foster social contact and disaster relief coordination, case finding, and mental health treatment capabilities. Pre-Disaster Psychopathology: How Does This Impact on Postdisaster Psychopathologic Presentations? It appears that the best predictor of postdisaster psychological distress and maladaptive functioning is pre-disaster psychological distress and psychiatric symptoms (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). Older clients who have a chronic mental illness such as schizophrenia, bipolar disorder, anxiety disorder, dementia, or personality disorder are at increased risk for the reactivation of a previously dormant disorder, the development of new distress, or worsened psychosocial function during and for an extended period of time, perhaps years, after a disaster. The main areas that need to be assessed are in the realms of mood symptoms, cognitive functioning, and thought process and behavioral control. The nature of the disaster may be critical in the production of new symptoms such as paranoid delusions. A 70-year-old male with chronic schizophrenia may have been
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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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8 Self-Help Tools for Older Persons
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Chapter 8 Self-Help Tools for Older
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9 Volunteers: Who Are They and What
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Chapter 9 Volunteers 159 munity com
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Chapter 9 Volunteers 161 RECRUITING
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Chapter 9 Volunteers 163 et al.). O
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Chapter 9 Volunteers 165 cial effor
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Chapter 9 Volunteers 167 nizations
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VOLUNTEERS PROVIDING AND RECEIVING
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Chapter 9 Volunteers 171 Gibson, M.
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Clinical Response to the Needs of O
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Table 10.1 PRE-DISASTER/BASELINE DO
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Table 10.2 DURING-DISASTER SYMPTOM
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Table 10.3 POSTDISASTER SYMPTOM DOM
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Table 10.5 POSSIBLE BENEFITS OF SEL
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12 Complementary and Alternative Ap
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Chapter 12 Complementary and Altern
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Where to Find a Therapist Chapter 1
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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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