Geriatric Mental Health Disaster and Emergency Preparedness

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