Geriatric Mental Health Disaster and Emergency Preparedness

Chapter 18 Disaster Related Elder Mistreatment (DREM) 363
the effects of these disabilities are exacerbated. An older person who has
lost the sensory functions of hearing or eyesight may misinterpret emergency
announcements or miss them altogether, while in the case of a sensory
loss related to smell the older person may be unable to distinguish
spoiled foods (Oriol, 1999).
Moreover, limited mobility is especially devastating as it potentially
leads to delays in evacuation, lack of access to services, dependence on
transportation assistance that may or may not be available, and even abandonment
( HelpAge International, 2006; Lamb, O’Brien, & Fenza, 2008;
Oriol, 1999). Carballo, Heal, and Horbaty (2006) wrote that older persons
with physical disabilities oftentimes are dependent on physical prostheses,
which are frequently lost or damaged during disasters and are very
difficult to replace. During disasters, the support systems that the vulnerable
or disabled older person has come to rely on are often lost, leaving
them abandoned unless aid workers make concerted efforts to identify
and help these vulnerable people.
Older persons with chronic medical conditions, such as hypertension,
heart disease, and arthritis, also are vulnerable to mistreatment (Lamb,
et al., 2008). In addition to potentially limiting a person’s physical function,
chronic medical conditions require constant care, either through a
regimen of medications or the attention of doctors and other health professionals.
However, in a disaster, medications can often be lost with no
recourse for replacement. Obtaining appropriate health care becomes
difficult as health resources are scarce or disorganized. Emergent issues
often are seen as more important than chronic conditions (Lamb, et al.).
In addition, disasters can often exacerbate debilitating chronic conditions
by disrupting the food and water supply and the provision of appropriate
shelter, increasing stress and exposing residents to infection (Mokdad,
et al., 2005). Such disruptions are especially worrisome for older persons
with altered immune function who are at an increased risk of infectious
disease (AARP, 2006). According to Greenough and Kirsch (2005,
p. 1546), the major health issue of Hurricane Katrina “was and will continue
to be the inability of the displaced population to manage their
chronic diseases.”
Psychosocial Characteristics
In addition to the physical issues associated with the aging process, there
are also covert psychosocial changes that can make the older person
vulnerable to DREM. Specifically, these include cognitive impairments
such as dementia and delirium as well as emotional problems such as