Geriatric Mental Health Disaster and Emergency Preparedness

284 Geriatric Mental Health Disaster and Emergency Preparedness
presents early in life in one’s 20s or 30s. Therefore, a careful history of previous
psychiatric illness is important in the context of understanding new
symptoms in the patient.
The client with mild symptoms of a dementia such as Alzheimer’s disease
or vascular dementia may also easily be affected by a disaster in a number
of deleterious ways. Having cognitive difficulties at baseline, the client
then becomes more disoriented and confused in the chaos or relocation to
new surroundings and the subsequent loss of familiar persons and cues in
the environment and as a result may experience a sense of insecurity and
dread. The client may develop a worsening ability to manage ADLs or selfcare
or be unable to communicate his or her distress to caregivers in the
community.
The assessment of prior mental illness in the geriatric client is crucial to
understanding the current presentation of any psychiatric symptoms. Are
we dealing with a completely new disorder without any roots in the past?
Are we observing the recurrence of an underlying disorder that has lain
dormant but has become activated by the disaster, or are the present symptoms
an extension of an active psychiatric illness that was not adequately
treated prior to the disaster and is now worse due to the stress of the current
disaster? In this assessment, we will also look at the onset of previous psychiatric
illness; the history of prior treatment and its success; and treatment
providers, including all member of the treatment team, case managers, the
therapist, assertive community treatment teams, and any agencies that have
been involved in the care of the client. For example, if adult protective services
had a prior relationship with the client and arranged through the courts
for a guardian, this information is necessary prior to making decisions to care
for the client in the disaster and postdisaster setting.
BEHAVIORAL DISTURBANCES
The assessment of the mental state of older persons must include a complete
evaluation of behavior. Often behavioral changes will be early manifestations
of another psychopathologic entity such as depression or anxiety.
The older person may become increasingly withdrawn and isolative and
refuse to leave his or her bed; not attend to personal hygiene, dressing, and
changing of clothing; not pay bills; and exhibit other abnormalities in routine.
The key element to investigate is change of behavior from the client’s
baseline. This requires direct interview as well as information from collat-