Geriatric Mental Health Disaster and Emergency Preparedness

Chapter 14 Geriatric Assessment for Differential Diagnosis 279
stable living in the community and functioning at a baseline level of independent
self-care with supervision from a case manager, therapist, and psychiatrist.
The attacks of September 11, 2001, witnessed repeatedly on a
television screen could easily resurrect a delusional belief that terrorists
were following this person and poisoning his food or medication. In response
to these new delusions, the client might fear taking his medication,
going outside, or eating his usual meals. The individual would quickly continue
to worsen due to the lack of his usual regimen of antipsychotic medication,
adequate nutrition, and reality testing obtained by routine psychosocial
contacts. A lack of social support and social isolation also increase the risk
of future psychological distress (Norris, Freidman, & Watson, 2002).
ASSESSMENT PROCESS
Given workforce limitations and shortages of mental health personnel with
training in geriatric mental health assessment, it is most useful to work in
an interdisciplinary team approach.
Assessment is a process that requires the use of all one’s senses in an
evaluation of the client. For example, the evaluator may note that a 70year-old
female appears confused and has a foul smell of urine. This may
be a clue to an untreated urinary tract infection now causing delirium. If
the examiner did not follow up on the foul odor, the etiology of the delirium
would have been missed. The timing of the assessment is a key factor in
informing further process. The nursing home resident who is evaluated in
the immediate aftermath of a hurricane may have a mental state revealing
shock, fear, and other features that may meet criteria for ASD. The mental
confusion, lack of awareness of one’s surroundings, and confusion may
also be indicative of a delirium (Silverman & Weston, 1995).
The timing of the assessment is important. Are we evaluating someone
in a triage setting during a disaster? Is the crisis still ensuing, and are we
performing a triage process to determine which clients need immediate
mental health treatment and which can wait for some time? In an immediate
ongoing disaster, the setting is not as important as a brief evaluation of
the mental state of the client. In this case, we are also trying to determine if
the presentation of psychiatric or psychological symptoms are a manifestation
of a delirium .
Delirium is a medical emergency and has a mortality rate of 15%. Thus,
the assessment during a disaster needs to identify those persons who are
suffering from delirium, for if we do not identify them in a timely manner,