Geriatric Mental Health Disaster and Emergency Preparedness

304 Geriatric Mental Health Disaster and Emergency Preparedness
frequently used are benzodiazepines and benzodiazepine-receptor targeted
drugs marketed as sleeping aids, such as zolpidem (Ambien).
Knowledge of the patient’s previous drug and alcohol use is important.
There are always a million reasons to drink, and bereavement is one of
them. A relapse into alcohol abuse by one mourners can add to the distress
of the others
As time goes on, caregivers have to focus more on functional impairment.
Functional impairment is distinguished from the sheer pain and
poignancy of grief. The impaired mourner may require help with grocery
shopping and housework. Money may be needed if there is no steady
income due to the inability of the impaired griever to return to work. Dealing
with impairment involves social service work and practical advice.
As time goes on, there is a return to preloss activities and functioning.
Is Treatment Evidence Based?
The efficacy of all forms of psychotherapy has been questioned. The possibility
even exists that it may be harmful. In controlled trial described by
Beem and colleagues (1999), widows who received grief counseling experienced
more sleep difficulty and other symptoms than did a control group.
Many trials have shown that when psychotherapy alone is compared
with organic treatments in severe psychotic illnesses, the organic treatments
have been superior. Strictly controlled trials of psychotherapy in
other conditions are difficult to carry out. A major obstacle is that anecdotal
evidence indicates that much depends on the individual psychotherapist.
The training of psychotherapists is more a matter of apprenticeship
than acquisition of formal academic credentials. In order to regularize
this situation and establish exactly what is being learned, some practitioners
have produced manuals with step-by-step instructions. By following
the manual exactly, a uniform kind of therapy can be produced
and reproduced. Manual-based psychotherapy can then be tested by
controlled trials. Several such manual-based therapies have been shown
to be successful, although meta-analysis has cast doubt on many of the
claims (Speilman, 2009). The difficulties facing research trials of psychotherapy
in general are magnified in bereavement studies. As we have
seen, there are ethical quandaries about even attempting to treat grief as
a medical condition.
Neimeyer (2008) concluded from a literature review that the evidence
for the general effectiveness of grief therapy relative to no treat-