Geriatric Mental Health Disaster and Emergency Preparedness

288 Geriatric Mental Health Disaster and Emergency Preparedness
critical and raises the issues of early case identification, preparation, and
planning. When did the person start showing signs of dementia? What is
their baseline functioning in terms of ADLs and IADLs? Dementia patients
with prior exposure to disasters often present an uncovering of symptoms
as the cognitive impairment progresses. A baseline assessment of
cognitive status using the MMSE is valuable.
Affective Disorder
The assessment of affective disorder includes alterations of mood states,
fear, terror, helplessness, rage, guilt, despair, depression, and hopelessness.
These may arise amidst the disaster or days or months after the event. Such
factors depend on the client’s premorbid functioning, previous psychiatric
illness, and proximity to the disaster. Nursing home residents moved from
their original locations into temporary or sheltering nursing homes in the
Gulf Coast reported increased prevalence of depression and anxiety (Laditka,
et al., 2008).
The assessment of older persons for mental distress must include a
careful understanding of their suicide risk, intent, and plan. The examiner
should not fear that inquiry into suicidal intent would put the idea in the
client’s head. Rather, suicidal intent and ideation is fraught with ambivalence
and uncertainty. Asking about suicide relieves the person, enables
them to share their frightening thoughts, and brings to their attention that
there is a compassionate listener. The risk of suicide is complex and multifactorial.
We must understand such variables as advanced age, gender,
history of prior suicide attempts, depression, and family history of suicide.
The client who appears depressed, refuses to speak, or shrugs off the examiner
is worrisome. Successful suicide generally takes planning and is not an
impulsive act. The clinician should look for recent behavioral changes, isolation,
decline in function, and reluctance to contact close friends or family.
The suicidal client may prepare by making a will, drafting letters to his or
her loved ones, and getting his or her affairs in order. One recent patient
was noted to have systematically sent all her photographs back to the persons
in the pictures and removed her possessions, packing them neatly in
bags along the corridor. A suicide note was found on a cabinet shelf.
Acute and Posttraumatic Stress
ASD and PTSD are categorized as anxiety disorders and have considerable
overlap and similarity with other anxiety disorders, such as generalized anxiety,
panic, and obsessive-compulsive disorders. The examiner should be