Geriatric Mental Health Disaster and Emergency Preparedness

Chapter 14 Geriatric Assessment for Differential Diagnosis 293
domestic violence and is likely to unleash and uncover emotions perhaps
buried for years under a defensive cover. The person may have learned to
block out uncomfortable feelings related to their former assault by using
denial or other defensive mechanisms, thus allowing the individual to continue
on in life with some semblance of normality. However, a disaster may
be the swift, startling event that throws all this to the wind and leaves the
person feeling raw, empty and alone, exposed, terrified, and uncertain how
to continue in his or her daily existence. It is the disruption of equilibrium,
the sheer terror and profound sense of being out of control, that may hearken
back to an event such as a sexual assault. In our example, a 65-yearold
female working in the World Trade Center saw the jet crash into her
building and uncertainly made her way out of the tower to the ground
level. There she witnessed the bodies of her fellow workers plunging to
the ground around her. She does not recall how she made her way home
to Astoria, Queens. She believes she was pushed along by the terrified
crowds. She continued to have nightmares and flashbacks of the event and
also developed symptoms of paranoia. She was convinced her neighbors
were stealing from her, coming into her yard, and rearranging the garbage
cans. She called the police several times to report their illegal acts only
to be told it was all in her head. She then began having vivid memories of
a sexual assault that had taken place 30 years prior. This earlier trauma had
occurred on her way home from work one evening. She did not know the
assailant and never reported the event to anyone, including her family. However,
after surviving the World Trade Center attacks and finally regaining
some sense of normality in her life, she continued to have these recurrent
vivid dreams of the sexual assault. She sought counseling and was able to
make a connection between the common mood states of the September 11,
2001, disaster and the previous assault. She identified a sense of being completely
out of control, unsafe, and at the mercy of another power. She continued
to be terrified but was relieved to have counseling to get her fears
out in the open after all these years. It is not unusual for victims of assault to
have such an uncovering of previous events after a disaster as the crisis recreates
the environment of insecurity, dread, and feeling out of control.
CONCLUSION
The goal of this chapter is to heighten the awareness of participants in the
psychological assessment of older persons following a disaster. An assessment
carried out in a multidisciplinary team approach with a longitudinal
sense of ongoing assessment and treatment planning is the most effective