Geriatric Mental Health Disaster and Emergency Preparedness

Chapter 14 Geriatric Assessment for Differential Diagnosis 281
hours, but this may be unreasonable given the circumstances and nature
of the disaster, setting, and skill of the examiner. Most critical information
regarding mental disorders can be obtained in an hour or less if the examiner
is trained to assess for those factors of most concern. A brief triage to
determine category or extent of pathology can easily be done within 15 minutes.
The staff should have had training on the basic features of the mental
status examination and its components. They should be able to obtain
this information in one session. It also may be useful to extend the assessment
process over several sessions. The assessment should always inform
the later diagnosis and treatment planning and therefore should be completed
so as to initiate treatment based on the severity of the problem. For
example, if the client appears to have severe symptoms of anxiety and dread
several days after living through a hurricane, the examiner must complete
the examination in order to make a referral to rule out any age-related medical
causes of anxiety. Commonly, medications may not be available to the
client, and the presentation of anxiety may be a sign of withdrawal from
a sedative, such as diazepam, that the client has been taking regularly for
years but now does not have access to.
We must prepare for and anticipate all difficulties in communicating
with our clients. This may include having translators available or making
arrangements for telephonic translation services. Many of our older clients
will have sensory impairments of one kind or another that will require us
to have sign language translators and amplification devices for hearing,
which can be obtained from electronic stores. Can the person speak since
they had a stroke? Are they able to write? In planning ahead and anticipating
services after disasters, these assistive devices are important to have on
hand. It is also useful to know prior to a disaster which clients are unable
to communicate due to neurological or physical problems, which clients
may have had a stroke, which are hearing impaired, or which are aphasic.
The functional status of the client pre- and postdisaster is important
in understanding the capacity of the client for self-care, the need for inhome
assistance, the need for referral to an institutional setting, or the augmentation
of in-home services. The standard scale for ADL assessment
should be performed at the onset of the evaluation and afterward at 3-to-
6-month intervals. Does the client ambulate alone? Can she bath and dress
herself ? Does she need any assistance with meal preparation, shopping,
cooking, and house cleaning? Can she pay her bills or are they found scattered
around the house in boxes with piles of other papers? The assessment
of functional status is a critical factor in determining the impact of a
disaster on an older client. The assessment of the client’s ability to perform