Geriatric Mental Health Disaster and Emergency Preparedness

366 Geriatric Mental Health Disaster and Emergency Preparedness
take on a lower priority from a responder’s or community’s perspective
( Ehrenreich & McQuaide). Additionally, stress from a disaster can lead
to physical or other forms of abuse (Oriol, 1999). The literature on older
persons who live with extended family (Oriol) shows a resulting stressful
impact on the existing social support structure of the host family. It may
lead to extensive stress on the family breadwinner with a subsequent
ripple effect of abuse and mistreatment (Kar, 2006; Lach, Langan, &
James, 2005). On the other hand, some cultures seem to be supportive of
such interfamilial relocation (HelpAge International, 2006) as long as
there are not any direct repercussions on the older person.
Common Risk Factors
Isolation, drug and alcohol addiction, psychiatric problems, dependence,
and familial stress are identified as the most critical among the high-risk
factors in the geriatric literature (Torgusen & Kosberg, 2006).
Elmore and Brown (2007) and Ehrenreich and McQuaide (2001) described
how the lack of a rigorous support structure necessary to deter
the isolation effect of a disaster might lead to heightened vulnerabilities
( Maeda, 2007). This has been confirmed in postassessment analysis of
evacuations (Laska & Morrow, 2006; McGuire, Ford, & Okoro, 2007) and
the subsequent relocation of older persons to government or community
shelters (Chaffee, 2005). Vulnerable people are susceptible to fraudulent
contractors and con artists (AARP, 2006; Oriol, 1999). Older populations
in shelters can become easy prey and targets for scammers and thieves
and even sexual assault (Ehrenreich & McQuaide; Elmore & Brown;
U.S. Department of Justice, 2002). Older persons who are dropped off at
shelters without care instructions or medical records (Lamb, et al., 2008)
and who may be disorientated or demented commonly receive inappropriate
medical treatment (Okumura, Nishita, & Kimura, 2008). There
seems to be no known pattern of neglect in the older community during
disasters (Bolin & Klenow, 1983, 1988). This leads to an increased potential
of prolonged isolation and invisibility to aid workers (Brown, 2007)
during the most needed time after a disaster (AARP, 2006).
Moreover, these risk indicators may be markers of unmeasured and
unobserved confounders as they can be the source of the relationship
between causal factors and elder mistreatment (Morrow, 1999). For example,
depression in a caregiver may be a causal risk factor in that a depressed
caregiver may be more likely to neglect the care of an elder by
virtue of the fatigue (O’Brien, 2003), social withdrawal, and lack of inter-