Geriatric Mental Health Disaster and Emergency Preparedness

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Chapter 16 The Experience of Vulnerability in Geriatric Combat Veterans 335 by letting down one’s guard is believed by many in the field to be the one symptom most resistant to nearly all clinical interventions. LIFE AFTER SEPTEMBER 11, 2001, FOR COMBAT VETERANS Since 2002, each cohort of geriatric combat veterans at the Brooklyn VA has participated in discussions and psychoeducation sessions on the topic of safety planning in the event of attack. They have participated in various surveys about the impact of September 11 upon their behavior, beliefs about safety, and beliefs about the future. These veterans have been invited to reflect upon changes they may have observed with regard to their subjective experience of PTSD. Thirty veterans per cohort currently participating in treatment at the Brooklyn Campus of NYHHC were asked to respond to the following questions: n Since 2001, has your concern about the threat of attack (weapons or biochemical) increased, decreased, or remained the same? n Since 2001, has your behavior changed signifi cantly with regard to travel, particularly into New York City, for reasons other than medical or fi nancial? n Since 2001, have you developed safety and emergency plans with your families and/or friends? n Since 2001, have you experienced an increase, decrease, or no change in your experience of PTSD symptoms? The results of this discussion revealed the following: Increased concerns about safety: 60% of WWII, 50% of Korean War, and 40% of Vietnam veterans indicated a greater concern for safety (U.S. Department of Veterans Affairs [Veterans Affairs], n.d.). Changes in behavior: 75% of WWII, 75% of Korean War, and 67% of Vietnam veterans reported changes in behavior resulting in a decrease in social activities and travel (Veterans Affairs, n.d.). Development of a safety plan: 75% of WWII, 75% of Korean War, and 80% of Vietnam veterans reported not developing a safety plan as a precaution in case of attack (Veterans Affairs, n.d.).
336 Geriatric Mental Health Disaster and Emergency Preparedness Subjective experience of PTSD: 90% of WWII, 80% of Korean War, and 80% of Vietnam veterans reported exacerbation of PTSD symptoms since 2001 (Veterans Affairs, n.d.). We have continued to provide an annual psychoeducational session and open discussion with each of the cohorts around the issues of safety planning. The beliefs and fears about future acts of war or terrorism are often the content of the group process. The results of a survey conducted in 2009 indicate that a significant number of veterans continue to meet the criteria for chronic and severe PTSD. These results suggest that for the population of geriatric combat veterans diagnosed with chronic and severe PTSD, most of whom were in treatment prior to September 11, there is marginal qualitative change in their beliefs and behaviors. As was stated previously, incremental gains are understood as improvement in this population. The combat veteran in general may subjectively experience an increase in symptoms of PTSD even after 50 years and participation in therapy (Schnurr, 1994). The veteran, as well as his or her family members and health care provider, may note increased anxiety in the face of the current global situation. This particular population may be more profoundly affected by such changes, which may manifest as an exacerbation of a preexistent condition that may or may not have been diagnosed and treated. For some within this population, a belief that was either left unspoken or said in hushed tones in the sanctuary of the clinical office has come to haunt them. That belief, born of fear or guilt or shame, is that somehow war has followed them home—it is here now. The inner battle they have lived through personally on a daily basis is matched externally in world events. The enemy within exists externally, and both are beyond their control. Suppressed feelings of helplessness and powerlessness surface and require attention. These veterans also express specific hopes that civilians will better understand at least some parts of their wartime experiences and treat them with more compassion and less criticism. This desire to be understood and received applies to their own families, many of whom have reacted to the veteran’s behavior without fully comprehending its origins or meaning. The desire to be understood and accepted is indisputably fundamental to all human beings, and it is no less true of combat veterans. Finally, many see the present situation as an opportunity to confirm the values they acquired in combat: there are some things worth fighting for and worth the cost of peace of mind. But many, although they
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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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14 This chapter focuses on the ment
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Chapter 14 Geriatric Assessment for
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386 Appendix I A Guide to Developin
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388 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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