Geriatric Mental Health Disaster and Emergency Preparedness

282 Geriatric Mental Health Disaster and Emergency Preparedness
ADLs (Katz, Ford, Moskowitz, Jackson, & Jaffe, 1963) and IADLs (Stuck,
et al., 1999) will predict his or her future need for services, need for institutionalization,
and level of care for outside support services.
HISTORY AND MENTAL STATUS EXAMINATION
The history of the present illness or the exploration of current signs and
symptoms starts from the moment the clinician makes contact with the client
or begins to have clinical information presented. For example, the clinician
may have advanced word that an 80-year-old man is being transferred
to the clinic due to behavioral problems, violence, and aggression. The clinician
now runs through a series of possibilities as to the likely cause of
this behavior. Is there a prior history of this behavior? Does the man have
a violent tendency? Or perhaps this is a man with Alzheimer’s disease who
has been displaced from his home and since becoming confused believes
he is back on the battlefield in Europe. What are the known or suspected
patterns of alcohol or substance abuse? All information that relates to
the patient is important and should be documented carefully in a medical
record.
The examination proceeds when the client arrives. Note his behavior
and his attitude toward the examination. Note what he is wearing, the state
of his hygiene, and the cleanliness of his clothing and hair and, for a woman,
note makeup and the state of her skin, nails, and extremities. Is the person
relaxed or anxious, agitated, pacing, restless, or aggressive? Can the client
sit still and maintain composure through the examination, or is he restless
and fidgeting with items on the desk? The orientation of the client is tested
by asking him where he is, where he was earlier in the day, and the components
of the date including month, day, date, year, and season. Prompts
can be given, but these must be noted in the record. Confabulation can be
present at this point in the examination. A memory-impaired client will
use this device to avoid the catastrophic reaction of being found out or discovered
to have cognitive limitations. The orientation of the client is an important
aspect in the diagnosis of dementia, delirium, and mood disorders
such as depression. Demented and delirious patients will be unable to answer
questions of orientation based on the severity of their underlying illness,
whereas depressed clients may give a response indicating they have
no interest in the question—“Don’t bother me, leave me alone.”
The mood and affect are to be considered next. The mood is a report
of how the patient is feeling in his or her own words. The affect is the range