Geriatric Mental Health Disaster and Emergency Preparedness

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18 Disaster Related Elder Mistreatment (DREM) IAN PORTELLI AND TERRY FULMER DEFINITION AND TYPOLOGY OF DREM Disasters, both natural and man-made, are tumultuous by their very nature and affect all people regardless of race, age, or class. However, the older population is particularly vulnerable during these times. During Hurricane Katrina in Louisiana, 64% of all fatalities were people over the age of 65, with 49% over age 75 (Brunkard, Namulanda, & Ratard, 2008). These numbers are particularly striking in that only 11.7% of New Orleans’s population (Baylor College of Medicine [BCM] & American Medical Association [AMA], 2006 ) were affected by the disaster. Of the older victims, 68% died in nursing homes, with some allegedly abandoned by their caretakers (AARP, 2006). Abandonment is one form of elder mistreatment, a practice potentially more damaging and most frequent in disaster situations (Castle, 2008). Disaster related elder mistreatment (DREM) as a term is still being adapted and explored to fit the disaster public health realm. The literature does not showcase a single definition to this ontology. For the purposes of this discussion, DREM is defined in the following ways: 1. An intentional action that causes harm or creates a serious risk of harm (whether or not harm is intended) to a vulnerable elder 361
362 Geriatric Mental Health Disaster and Emergency Preparedness by a caregiver or other person who stands in a trust relationship with the elder 2. Failure by a caregiver to satisfy an elder’s basic needs or to protect the older person from harm during a time of disaster During a disaster actions such as the following can lead to trauma responses that can endanger the life of the older person (Islam, Muntner, Webber, Morisky, & Krousel-Wood, 2008): 1. Physical, sexual, or emotional abuse (Graziano, 1997, 2003) 2. Neglect 3. Financial or material exploitation 4. Abandonment This chapter will examine the traits of older persons that put them at risk for DREM, along with the steps that aid public health response to recognize and prevent this type of mistreatment. VULNERABILITY OF THE OLDER POPULATION Old age is a time of transition in terms of both physical and psychosocial changes. These changes, along with existing cultural and underpinning sociodemographic characteristics, make the older population particularly vulnerable to mistreatment (Geroff & Olshaker, 2006). During times of disaster, these vulnerabilities are exacerbated and stretched to their limits (Kohn, Levav, Garcia, Machuca, & Tamashiro, 2005), increasing the importance of recognizing such traits and ensuring the older population is cared for (Castro, Persson, Bergstrom, & Cron, 2008). Altered Physical Functioning The most vulnerable older persons are those with a physical disability . According to Rothman and Brown (2007, p. 16), “people with any disability are the ones most likely to suffer a decline in their functional status during or after a disaster.” Physical disability can take many forms, such as general frailty (Cefalu, 2007), a lack of mobility, or even impaired hearing or vision. Such functional impairments hinder the frail older person from performing basic ADLs such as preparing meals, using the restroom, or managing their medications and, in effect, make them dependent on outside caregivers, family members, or friends and neighbors (BCM & AMA, 2006; Krousel-Wood, et al., 2008; Rothman & Brown). In a disaster,
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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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15 Bereavement and Grief: What Is N
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The Length of Mourning Chapter 15 B
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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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