Geriatric Mental Health Disaster and Emergency Preparedness

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Chapter 16 The Experience of Vulnerability in Geriatric Combat Veterans 339 in the context of the veteran’s social and familial functioning and incorporates psychodynamic group process. Films are used as catalysts for discussion. This has met with a good degree of success with Korean and WWII populations. Movie therapy involves viewing videos followed by discussion during two to three counseling sessions. The movies are selected to challenge the limitations and prejudices of the defense mechanism of avoidance of beliefs about self, others, and the world. The discussions allow the veteran to use the objective narrative of the video to project an aspect of his or her own questions and unresolved material. Such discussions have resulted in increased insight, reduced avoidance, and a reduction in anxiety. There has been a noticeable enhancement of feelings of selfconfidence and cognitions/beliefs about safety and trust with regard to the past that are more adaptive, constructive, and realistic. Other psychosocial rehabilitation activities include (1) education about various resources and concrete services available to this population within the VA and the larger community, (2) enhanced social interaction through the use of social activities outside the VA, (3) the support and assistance of veteranled initiatives related to care for troops and the wounded, and (4) monthly multifamily support groups. SUMMARY Presently, there is a very sparse body of literature that discusses the use of EBP, specifically CBT, with the geriatric veteran population. With the trend in the VA to make CBT available to all veterans who either request it or are assessed as potential candidates for this therapy, it is likely that the body of research literature on this population will expand. As discussed earlier, asking basic questions of older combat veterans with chronic and severe PTSD suggests that while some of our therapeutic efforts have been helpful, the overall outcome has not produced an appreciable reduction in symptom expression for this population. Given the therapeutic success with younger veterans, it is expected that CBT would result in a reduction in symptoms in the older veteran population with chronic and severe PTSD. The philosophy and protocols of this type of intervention may help the older veteran understand his or her reactions to the threat of global and local terrorism, war, and biochemical attacks. In this process, perhaps the older veteran will discover his or her inner strength and resources hidden by fear. It is worth repeating that CBT requires extensive therapist training. Untrained professionals or paraprofessionals should not utilize CBT.
340 Geriatric Mental Health Disaster and Emergency Preparedness REFERENCES American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (text revision). Washington, DC: Author. Blake, D., Weathers, F., Nagy, L. M., Kaloupek, D. G., Charney, D. S., Gusman, F. D., et al. (1998, July). Clinician administered PTSD scale for DSM-IV (Rev.). Boston: National Center for PTSD, Behavioral Science Division. Bryce, I. (Producer), & Spielberg, S. (Director). (1989). Saving Private Ryan [Motion picture]. United States: DreamWorks. Engdahl, B., & Eberly, R. (1994). Assessing PTSD among veterans exposed to war trauma 40–50 years ago. NCP Clinical Quarterly, 4, 13–14. Erickson, E. (1980). Identity and the life cycle. New York: Norton. Figley, C. (1985). Trauma and its wake: Stress disorders among Vietnam Veterans: Vol.1. New York: Brunner/Mazel. Foa, E. B., Keane, T. M., & Friedman, M. J. (2000). Effective treatments for PTSD. New York: Guilford Press. Foa, E. B., Hembree, E. A., & Rothauma, B. O. (2007). Prolonged exposure therapy for PTSD. New York: Oxford University Press. Fowler, J. (1981). Stages of faith: The psychology of human development and the quest for the meaning of life. New York: Harper. Friedman, M. J., Keane, T. M., & Resick, P. A. (Eds.). (2007). Handbook of PTSD science and practice. New York: Guilford Press. Hyams, K. C., & Wignall, R. (1996). War syndromes and their evaluation: From the U.S. Civil War to the Persian Gulf War. Annals of Internal Medicine, 125, 398–405. Izzo, J. (n.d.). Values and character traits in the geriatric combat veteran population. Grand rounds presented at the Brooklyn Campus of the NYHHC, VA Medical Center, Brooklyn, New York. Nussbaum, M. C. (2007). Upheavals of thought, the intelligence of emotions. New York: Cambridge University Press. Resick, P. A., Monson, C. M., Price, J. L., & Chard, K. M. (2007) Cognitive processing therapy, veteran/military version trainer ’s manual. Washington, DC: Department of Veterans Affairs. Schnurr, P. P. (1994, Winter). The long-term course of PTSD. NCP Clinical Quarterly, 15–16. Tick, E. (2005). War and the soul: Healing our nations veterans. Wheaton, IL: Quest Books. U.S. Department of Veterans Affairs, Offi ce of Public Affairs. (2008). America’s wars. Retrieved November 9, 2008, from http://www.va.gov U.S. Department of Veterans Affairs. (n.d.). [Survey of veterans in treatment at the Brooklyn Campus of the NYHHC, VA Medical Center, Brooklyn, New York, regarding impact of September 11, 2001 events.] Unpublished raw data. Weathers, F. W., Husk, A. J. A., & Keane, T. M. (1991). PCL-M. Boston: National Center for PTSD, Behavioral Sciences Division. Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993, October). The PTDS Checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the 9th Annual Meeting of International Society for Traumatic Stress Studies, San Antonio, Texas. Zanuck, D. (Producer), & Johnson, N. (Director). (1956). The man in the grey fl annel suit [Motion picture]. United States: 20th Century Fox.
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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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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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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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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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