Geriatric Mental Health Disaster and Emergency Preparedness

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Chapter 16 The Experience of Vulnerability in Geriatric Combat Veterans 319 PTSD in West Haven and authored by some of the leaders in this field: Robert Rosenheck, Al Fontana, Paula Schnurr, Matthew Friedman, Allan Spiro, Paula Resick, and others whose efforts and work have contributed to a better understanding of geriatric veterans with PTSD. There is also a growing body of literature written by the mental health community outside the VA that discusses the needs and problems of an aging veteran population with PTSD. Research on this aging veteran population is consistent with our experience at the Brooklyn Campus of the New York Harbor Healthcare (NYHHC), VA Medical Center, and also confirms the observations and experience of other mental health professionals who treat these populations. It is important for the reader to keep in mind that the discussion in this chapter is limited to those veterans with chronic and often severe PTSD who are in active treatment. This chapter aims to enhance the reader ’s understanding of how this population continues to be affected by their beliefs about their combat experiences. Some veterans diagnosed with PTSD may become disabled as a result of the severity of their symptoms. Their disability manifests as an impairment of social, industrial, or familial function or a combination. This chapter also focuses on the impact of terrorism and war upon the beliefs and behaviors of the cohorts in this population, particularly in relation to the expression of PTSD symptomatology. The effects of aging and memory and the psychological dynamics of powerlessness, vulnerability, and hopefulness as manifested by this population are examined. The spiritual and existential implications of veterans who are thought to have lived far beyond their days of greatness are explored. The chapter concludes with a brief summary and suggestions for practice working with a geriatric veteran population. DEFINITION OF TERMS Veteran A veteran is a person who has been employed and/or had years of experience in a service or occupation (especially military). Combat Veteran For the purposes of this chapter, a combat veteran is a soldier who served in a war zone either in direct combat or in a support unit located in the theater of activity.
320 Geriatric Mental Health Disaster and Emergency Preparedness Posttraumatic Stress Disorder Over the centuries, this disorder was recognized by physicians and psychiatrists and described in a variety of ways. In the Civil War, what we now call PTSD was known as soldiers heart (Tick, 2005) and war nostalgia (Hyams & Wignall, 1996). The term shell shock (Figley, 1985) came into use in WWI and the terms war neurosis or traumatic war neurosis during WWII (Friedman, Keane, & Resick, 2007) continuing through the Vietnam War. In 1985, the Committee of Anxiety Disorders for DSM-III defined the term posttraumatic stress disorder (Friedman, et al.). PTSD usually manifests as a mixture of anxiety and depression and varies in degree and severity from individual to individual. The range of possible symptoms is as follows: repeated, disturbing memories, thoughts, and images of the traumatic event(s); repeated, disturbing dreams of the traumatic event(s); suddenly acting or feeling as if the event were happening again; feeling very upset when something is reminiscent of the stressful or traumatic event; physical reactivity such as palpitations, difficulty breathing, and sweating when reminded of the traumatic event; avoidance of thinking or talking about the event; avoidance of activities that remind the person of the event; difficulty remembering aspects of the event; loss of interest in things one used to enjoy; feeling distant or cut off from others; emotional numbness and difficulty having and expressing loving feelings toward those close to the person; negativistic thinking; a sense of a foreshortened future; difficulty falling asleep and remaining asleep; irritability and angry outbursts; difficulty with concentration; hypervigilance; and hyper-reactivity (American Psychiatric Association, 2000). PTSD as a condition can be classified as subthreshold (i.e., the disorder ’s impact on the functioning of the individual is minimal, with little to no impairment reported) to moderate or severe (indicating a substantial impairment in each sphere of a person’s life). PTSD also may be classified as chronic when the individual has lived with the disorder for an extended period of time prior to entering treatment (Engdahl & Eberly, 1994). As with any medical or psychiatric condition, the longer treatment is delayed the more entrenched the symptoms become in the person’s lifestyle. Geriatrics Geriatrics is a concentration in health sciences that focuses on the process of aging and diseases typically found in older adults. For the purposes of this chapter, Vietnam veterans are considered to be geriatric for two reasons: (1) because some are already within this category, and (2) because they are the fastest growing geriatric cohort in re-
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Geriatric Mental Health Disaster an
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Geriatric Mental Health Disaster an
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Dedicated to Flo Aaroe, who personi
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Contributors xi Foreword by Robert
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14 Geriatric Assessment for Differe
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xii Contributors Terry Fulmer, PhD,
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xiv Contributors Douglas M. Sanders
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Foreword With the increase in the n
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Preface The rage you feel does more
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Preface xxi and (3) influence the d
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Preface xxiii as key to the prepara
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Acknowledgments In connection with
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1 A Primer for Disaster and Emergen
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Chapter 1 A Primer for Disaster and
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2 Older Persons in Disasters and Em
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Chapter 2 Older Persons in Disaster
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NORMAL CHANGES WITH AGING ORGANS/SY
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Immune Function Laboratory Tests Em
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48 Geriatric Mental Health Disaster
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Table 3.3 GEC GEPR COLLABORATIVE PR
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Table 3.3 GEC GEPR COLLABORATIVE PR
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Community Response to the Needs of
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5 National and Cross-National Model
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Chapter 5 National and Cross-Nation
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6 Supervision and Facilitated Refl
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Chapter 6 Supervision and Facilitat
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INTERNATIONAL TREATIES Team Respons
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120 Geriatric Mental Health Disaste
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8 Self-Help Tools for Older Persons
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Chapter 8 Self-Help Tools for Older
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9 Volunteers: Who Are They and What
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Chapter 9 Volunteers 159 munity com
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Chapter 9 Volunteers 161 RECRUITING
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Chapter 9 Volunteers 163 et al.). O
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Chapter 9 Volunteers 165 cial effor
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Chapter 9 Volunteers 167 nizations
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VOLUNTEERS PROVIDING AND RECEIVING
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Chapter 9 Volunteers 171 Gibson, M.
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Clinical Response to the Needs of O
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Table 10.1 PRE-DISASTER/BASELINE DO
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Table 10.2 DURING-DISASTER SYMPTOM
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Table 10.3 POSTDISASTER SYMPTOM DOM
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Table 10.5 POSSIBLE BENEFITS OF SEL
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12 Complementary and Alternative Ap
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Chapter 12 Complementary and Altern
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Where to Find a Therapist Chapter 1
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Self-Care Chapter 12 Complementary
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13 The Interdisciplinary Treatment
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Chapter 13 The Interdisciplinary Tr
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Choose solutions Review literature
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380 Appendix I A Guide to Developin
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390 Appendix II Glossary of Terms C
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A AAGP. See American Association fo
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community initiatives/lessons learn
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depression v., 287 during disasters
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Emergency preparedness, gaps in tra
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adverse reactions to, 226 conclusio
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health care provider training on, 7
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physical changes/resultant weakness
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supervisor component of, 110 -113,
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Spirituality of African Americans/A
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