Geriatric Mental Health Disaster and Emergency Preparedness

300 Geriatric Mental Health Disaster and Emergency Preparedness
Many culturally determined rituals have evolved around mourning.
Such rituals may even mandate loud shouting and tearing of clothing. It
is important for helpers to try to learn about these.
Religion
Spirituality can be helpful in resolving grief (Walsh, King, Jones, &
Blizard, 2002), and the elderly are more likely than the young to be involved
in organized religion and attend a place of worship. Training helpers
should include instruction by clergy. Many of the theological issues
related to grief are complex and demand knowledge of matters such as
liturgy and interdenominational differences as well as pastoral counseling.
Questions arise regarding theodicy, that is, the belief in God’s goodness
in spite of the existence of evil in the world, especially in disaster
situations. Theodicy is dealt with in popular works such as Kushner’s
When Bad Things Happen to Good People (2001) but can be best understood
and expounded upon by a qualified priest, minister, or rabbi.
Disbelief or Forgetting
Disbelief, or forgetting that a loved one has gone, also occurs in nondisaster
situations. In everyday life, we sometimes experience memory
lapses or cognitive dissonance when something familiar changes. Such
disbelief provides transient anesthesia but gives rise to renewed paroxysms
of grief when remembrance of reality returns. A complication in
disaster situations is that there may be actual uncertainty due to compromised
communication systems.
Another complication is that older bereaved persons may already
have memory problems. Outside of disaster situations, demented older
persons may continue to believe long-departed spouses are still alive. A
frequent problem in geriatric practice is that of informing a demented
patient about the loss of a close relative. The family will often come to
the health professional and ask him or her to perform this task. It is recommended
that this should only be done once. After the initial information
has been understood, there is no need for reminding, and we can
presume that disbelief is comforting to the demented patient.
Hallucinations
Hallucinations are very common in bereavement and occur in about half
of those widowed (Rees, 1971). They may be a sense of the presence of