Geriatric Mental Health Disaster and Emergency Preparedness

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-