Geriatric Mental Health Disaster and Emergency Preparedness

286 Geriatric Mental Health Disaster and Emergency Preparedness
gastrointestinal upset, and vague symptoms that do not respond to standard
therapy (Boscarino, 1997).
The help-seeking behavior of the depressed and anxious patient often
manifests with a somatic presentation and the client needs to be encouraged
to reveal the cause of the distress. Often in the somatic disorders, however,
the goal may not be a cure but rather symptom relief. The client may be
excessively using sedatives, hypnotics, or opiates. A careful assessment includes
all medication’s side effects, dosing, and the nature of their use. The
education of the client focuses on the dangers of the excessive use of medication—such
as falls and mental confusion or the risk of addiction. We may
see the overuse of emergency rooms, office visits, or clinic appointments
to seek relief from the psychological distress of the untreated effects of a
disaster.
Delirium
The current assessment must focus on the acute presentation of psychological
symptoms and signs of illness. The most pressing and urgent to
detect is delirium. Delirium—also referred to as acute confusional states,
encephalopathy, or acute brain failure—is an acute mental status change
presenting with confusion, disorientation, global cognitive impairment, the
inability to attend to a situation, reversal of the sleep-wake cycle, and agitation
or marked inactivity and social withdrawal (American Psychiatric
Association, 2000). The etiology may be multifactorial, and the outcome in
15% of cases of delirium will be death. The frail elderly in a disaster are vulnerable
to the onset of delirium. Medication may be a significant issue if
taken in excess, if not taken at the right time, or if not taken at all. A patient
with cardiac disease who is prescribed a daily dosage of digoxin may
be stable on her usual medication regiment. During a disaster, her medication
may be misplaced, or she may be overwhelmed and forget to take her
usual dose. This may lead to worsened cardiac function, decreased blood
flow to the brain, congestive heart failure, and subsequent mental confusion.
Any disruption of blood flow, oxygen, or glucose to the brain will result
in some degree of mental confusion. A patient with mild cognitive impairment
who is taking such heart medication may forget they have taken their
daily dose and take one or two extra for the day. Digoxin has a narrow therapeutic
index, and accidental overdose can cause mental confusion. The list
of medications that can result in mental confusion or delirium in excess
or when not taken at the appropriate time is extensive. Common offenders
that should be carefully considered included steroids, beta agonists, anti-