Geriatric Mental Health Disaster and Emergency Preparedness

292 Geriatric Mental Health Disaster and Emergency Preparedness
ill tend to have limited support systems and coping skills. Late-life schizophrenia,
paraphrenia or late-onset psychosis, or delusional disorder may
also occur in the older client. Particularly noteworthy are well-organized
paranoid delusions, often of a persecutory nature. The client may not have
had prior psychiatric treatment. Often the precursor to this late-onset psychosis
is a premorbid schizoid personality or paranoid personality disorder.
For instance, the extensive media coverage of September 11, 2001, may
have induced some patients to have active delusions that terrorists were personally
persecuting them. For some older persons, this may have led to
acute decompensation of their clinical status. Many times, the decompensation
starts with a paranoid delusion that food is tainted or poisoned. The
next step may be nonadherence with medication, typically an antipsychotic,
followed by further decline in functioning and increased positive symptoms
of psychosis, paranoia, and fear. At this point, the patient might discontinue
treatment with the therapist and psychiatrist, isolate himself in his room, and
refuse to participate in usual activities. Television coverage of the disaster
would continue to reinforce the paranoid thoughts and fears of retribution
for imagined crimes.
We should consider that any person with a chronic mental illness is
more vulnerable to the impact of a disaster than the general population.
The mentally ill are stigmatized, feel shunned and disregarded, and have
flaws in self-esteem and sense of self-worth. The disruptive effects of a
disaster on their sense of security and safety, further breakdown in their
support systems, and disequilibrium all add to a more fragmented sense
of self and increased feelings of distress in the chronic mentally ill.
One significant myth in the study of personality disorders in the older
client is that personality disorders tend to become less clinically important.
To the contrary, personality disorders in older persons tend to be more debilitating
regarding individual functioning, self-esteem, and sense of independence.
The relationship between personality disorders and disasters is
complex. The presence of a highly anxious, passive, dependent personality
disorder is a risk factor for escalating anxiety, dread, and disequilibrium
after a disaster. The person who has difficulty with independent planning,
self-care, and organization of surrounding supportive networks is left after
a disaster with increased distress, bewilderment, and panic.
A CASE
A disaster will have a noticeable impact on a person with a prior history of
traumatic abusive assault, long-standing physical or sexual abuse, rape, or