Geriatric Mental Health Disaster and Emergency Preparedness

Chapter 14 Geriatric Assessment for Differential Diagnosis 287
hypertensive medications, caffeine, stimulants, sedatives, hypnotics, tranquilizers,
analgesics, and anti-inflammatories. Any medication, even an
over-the-counter medication, can cause mental confusion. The examiner
needs to make a thorough list of the client’s medication and dosing schedule
and also obtain a sense of the client’s medication adherence.
Another area of assessment for delirium relates to a careful mental status
examination of the client’s ability to maintain a lucid, cogent train of
thought or logical thought process as manifested by his or her ability to pay
attention despite outside stimuli. Hallucinations may accompany a delirium.
These are typically visual or tactile hallucinations—perceptual disturbances
that are immediate, appear real, and are usually terrifying to the
client. Auditory hallucinations are not as common but may manifest as one
or several voices inside or outside the head giving a running dialogue of
critical or derogatory statements. This type of hallucination is more commonly
seen in the patient with schizophrenia.
Delirium is most worrisome in the older client as it is easily mistaken
for depression. Delirium tends to present in two ways. The first, most dramatic
is the psychomotorically agitated person ranting, screaming, and pulling
out intravenous lines in the hospital. He is disoriented, paranoid, and
terrified. Any prior experience of captivity, imprisonment, or battle may
emerge during this state, so real and immediate that the person truly is on
the field fighting off the enemy. The second type of delirious presentation,
more likely to be confused with depression, is the motorically slowed person
who is lethargic, curled in a fetal position, and barely responsive. Such
a person likely would be confused and disoriented with clouding of consciousness.
He would appear depressed and sullen; if the underlying cause
of the delirium were not quickly ascertained, he would further lapse into
more profound mental clouding, coma, or death.
Dementia
It cannot be overstated that a client with a dementing disorder prior to a
disaster is at significant risk for functional decline in the context of a disaster
setting. Estimates in the population are that 10%–30% suffer some form
of cognitive impairment (Albert, 2004). The distress associated with a disaster;
the disruption in the basic safeguards of one’s existence; and the loss
of power, food, supervision, and safety pose significant concerns for this vulnerable
cohort. The assessment of the patient with dementia requires compassion,
skill, and basic human concern for a vulnerable person unaware
of the gravity of the circumstances. The patient’s historic information is