Geriatric Mental Health Disaster and Emergency Preparedness

290 Geriatric Mental Health Disaster and Emergency Preparedness
met. As in ASD, these include the three hallmark categories of avoidance,
re-experiencing, and arousal. The risk of PTSD appears to be greater for
those previously exposed to a severe disaster setting; the impact of total disaster
involvement may be cumulative over a lifetime (Engdahl, Eberly, &
Blake, 1996; Fields, 1996). Therefore, the combat veteran of WWII evacuated
from a nursing home who has early dementia and physical limitations
may have a resurgence of PTSD symptoms previously held in check. There
does not appear to be an increased risk for the geriatric client to develop
PTSD. As noted earlier, there may be some degree of inoculation effect
from experiences in a previous disaster, learned strategies, life skills, coping
methods, and the ability to organize oneself amidst a new crisis.
WWII veterans admitted to a psychiatric unit for other mental health
issues were found to have a 54% prevalence of prior PTSD; 27% had current
criteria for PTSD (Fontana & Rosenheck, 1991).
Alcohol, Prescription Drug, and Substance Use
There is a strong comorbid relationship in the general population between
PTSD and alcohol and substance abuse disorders (Chilcoat & Menard,
2003). One third of patients with PTSD have a substance abuse disorder,
and 6% of those with a substance abuse disorder have comorbid PTSD
(Kessler, et al., 1995). The older client may turn to alcohol, prescription
drugs, or illicit drugs during and after a disaster. The pattern of alcohol use
in older persons tends to be in two major groupings : the chronic alcohol
abuser and the moderate drinker . The first is the client who has engaged
in habitual use of alcohol and may have increased the use recently to excessive
levels. The person who has used alcohol for many years will show
consequences of its use such as signs of alcohol-related dementia, hepatitis,
poor self-care, comorbid tobacco use, and a history of multiple falls
and fractures. This group is known to be inattentive to their health concerns
and may have multiple chronic medical problems such as cardiovascular
disease, diabetes, chronic respiratory illness, and hypertension.
They may have a pattern of excessive use of alcohol since adolescence with
or without efforts to curtail their drinking.
As disaster may lead to anxiety, fear, and dread, the older client who
reports minimal alcohol use also may turn to alcohol for self-medication
of symptoms. Since alcohol is a depressant, this use over time only makes
mood symptoms worse, and the client may sink deeper into despair. The
examiner should always inquire into the patterns of the client’s current
use of alcohol.