Geriatric Mental Health Disaster and Emergency Preparedness

Chapter 14 Geriatric Assessment for Differential Diagnosis 291
Prescription drug use may escalate after a disaster. The older client is
likely to have been prescribed some type of sedative or hypnotic prior to
a disaster. Older persons are often overmedicated by their primary care
physicians and mental health specialists with an array of psychotropic medication,
each of which increases the risk of falls, confusion, and cognitive
slowing. After a disaster, it is a knee jerk reaction by physicians to prescribe
sedatives to ease anxiety and distress, yet there is a substantial risk of worsening
the overall functioning of the client.
Over-the-counter medications are not benign. The examiner must
inquire into all medication taken by the client and urge them to carry an
updated medication list on their person at all times. The client may have
multiple health care providers, each prescribing their own medication but
unaware of what the others have prescribed. Following Hurricane Katrina,
a survey of 680 evacuees living in Houston shelters during September
2005 showed that 41% reported having chronic health conditions such as
heart disease, hypertension, diabetes, and asthma; 43% indicated they were
supposed to be taking a prescription medication and 29% of those said they
had problems getting prescriptions filled. Most of those surveyed did not
give their age, but many of the people in shelters were older persons (Washington
Post, Kaiser Family Foundation, & Harvard University, 2005).
The assessment should include a thorough review of all medication
the client is prescribed including dosages, timing, side effects, and recent
changes. If making a home visit, the clinician should look through the medicine
cabinet and encourage a thorough cleaning. If possible, staff should
discard unused medication from the home as older persons tend to stockpile
these for no reason. This is very important if the patient has any suicidal
or depressive symptoms. The examiner should urge the patient to
document and carry on his or her person an up-to-date, complete list of
medications from all physicians and health care providers. The clinician
should also ask clients if they know what their medical problems are and if
they understand what each medication is for, including over-the-counter
medications, vitamins, natural remedies, and the like as these are rarely
benign and may be taken in excess.
Schizophrenia and Chronic Mental Illness
Schizophrenia is a chronic psychiatric illness that manifest in late adolescence
or early 20s. In regard to disasters, we must understand that patients
with any chronic mental illness may be severely impacted by the distress,
fear, and dread common to the general population. The chronic mentally